AMA Opposition to Single-Payer Care Main Issue of Debate at Annual Meeting

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Several AMA House of Delegates decisions are in line with ACP policies, recommendations

July 12, 2019 (ACP) – The American Medical Association (AMA) has moved closer than before to abandoning its opposition to single-payer health insurance. At its annual meeting in June, AMA delegates ultimately voted against withdrawing opposition, but it was by a narrow margin of 53 to 47 percent.

“Five or six years ago, that would have lost 80 percent to 20 percent,” said Dr. William Golden, chair of ACP's delegation. “There's quite a bit of movement toward looking at other ways of providing access to health care.”

Dr. Doug DeLong, chair of the ACP Board of Regents, urged the AMA delegates to take this step. In comments to the AMA Internal Medicine Caucus and Section Council, he said the AMA “needs to be open to supporting approaches that would truly achieve universal coverage, such as by giving everyone a choice of enrolling in a public plan, similar to Medicare but with better benefits; if they prefer, they could keep their own private individual or employer-based insurance, as long as it meets federal benefit standards.” Additionally, during the meeting, the delegates passed a resolution, based on one that ACP had introduced, directing the AMA to study public options as a way of increasing coverage.

AMA has seemingly evolved on this issue because, according to Golden, “there's a younger crew of delegates and more open-mindedness. The solo, small-practice physician is not as predominant. They're working within corporations and are familiar with health systems and accountable care organizations.”

In a bit of good news, AMA delegates supported a push for improvements to the Affordable Care Act. The AMA wants to both expand eligibility and boost the amounts of premium tax credits and cost-sharing reductions. This move is in line with ACP's priorities as discussed in a paper published in April in the Annals of Internal Medicine.

AMA delegates also aligned with ACP priorities when they approved a policy to expand physician access to patient records about substance use disorder treatment. ACP cosponsored a resolution regarding this issue.

“Currently regulations about privacy for patient information regarding substance use disorder treatment are more stringent than those for other parts of a patient record,” said DeLong. “Better integrating this information reduces barriers to care coordination; it can help us identify patients at increased risk for chronic diseases associated with substance use disorder; and, it could improve general health outcomes for these patients.”

On another front, ACP supported a successful resolution in favor of allowing mature minors to bypass their parents and seek immunization if necessary.

Overall, the votes represent the evolution of the AMA, Golden said. “Things are being voted on and adopted that would have been nonstarters seven years ago in areas such as proactive policies regarding patients and underrepresented groups such as the LGBT community, prisoners and immigrants.”

Also, during the meeting, ACP member Dr. Noel Deep won his bid for re-election to the AMA Council on Science and Public Health. ACP now has 23 voting members among the AMA's more than 600 delegates – a record number – and former ACP president Dr. Sandra Adamson Fryhofer serves on the AMA Board of Trustees.

“ACP is a well-respected thought leader and holds leadership positions that allow us to advocate on behalf of internal medicine,” Golden said. “We've been challenging some of [the AMA's] policies, and now they're much closer to ACP's than they were even just five years ago. That's all very positive for the College.”

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