AMA Delegates Adopt Comprehensive Measure Supporting Health Care Reform

AAFP Leaders Say Final Resolution Aligns With Most AAFP Goals for Reform

By Barbara Bein
Posted: 11/11/2009, 4:10 p.m.

The AMA threw its support behind health system reform on Nov. 9 during the 2009 interim meeting of the AMA House of Delegates in Houston. And according to members of the Academy's delegation, the final measure adopted by the delegates carries forward much of the Academy's own message on reform.

Photo of AAFP President Lori Heim, M.D., at the 2009 AMA interim meeting

AAFP President Lori Heim, M.D., stresses the importance of continuing the conversation about health care reform with federal lawmakers. Heim spoke during the 2009 interim meeting of the AMA House of Delegates in Houston.

"We want discussion of health care reform to proceed," AAFP President Lori Heim, M.D., of Vass, N.C., told AAFP News Now. "There were multiple resolutions that were offered that would have tied the hands of the AMA Board of Trustees, and we spoke in strong opposition to those."

After hours of testimony from delegates during a Nov. 8 hearing of the AMA Reference Committee on Legislative Advocacy, as well as additional spirited debate during the Nov. 9 business session of the house, AMA delegates adopted a comprehensive substitute measure that encompassed eight disparate resolutions on the topic -- including one submitted by the AAFP -- and reaffirmed the AMA's commitment to health system reform.

The substitute resolution delegates adopted (2-page PDF; About PDFs) states that the AMA is committed to working with Congress, the Obama administration and other stakeholders to achieve enactment of health system reform that includes the following key components of AMA policy:

health insurance coverage for all Americans;
insurance market reforms that expand affordable coverage choices and eliminate coverage denials based on pre-existing conditions or arbitrary caps;
assurance that health care decisions will remain in the hands of patients and their physicians;
investments in and incentives for quality improvement activities and prevention and wellness initiatives;
repeal of the sustainable growth rate-based Medicare physician payment formula;
implementation of medical liability reforms to reduce the cost of defensive medicine; and
implementation of streamlined and standardized insurance claims processing requirements to eliminate unnecessary costs and administrative burdens.

Dale Moquist, M.D., of Sugar Land, Texas, chair of the AAFP delegation to the AMA, explained that the measure that ultimately garnered the delegates' backing also encompasses the Academy's call for the AMA House of Delegates to "support AMA leadership in their unwavering and bold efforts to promote health care reform in the United States."

According to Moquist and other Academy delegation members, probably the most important feature of the measure that the delegates adopted is what it did not contain -- namely, opposition to a public plan option and a call for the AMA board to rescind its support of the Affordable Health Care for America Act, H.R. 3962 (at the THOMAS Web site, type "H.R. 3962" into the search field after selecting "Bill Number"), which was narrowly approved by the U.S. House of Representatives on Nov. 7.

Photo of AAFP Board Chair Ted Epperly, M.D., at the 2009 AMA interim meeting

"If we do not better pay primary care doctors, we will not have a primary care system," AAFP Board Chair Ted Epperly, M.D., tells AMA delegates. "If we do not have a primary care-based system, we do not have a health care system."

Both proposals were included in resolutions originally submitted to the house, but were vigorously opposed during reference committee testimony and, eventually, stripped out by the delegates.

"We were pleased that opposition to the public plan option and to H.R. 3962 were successfully overturned by the AMA House of Delegates as a whole, as members of the AMA Board of Trustees must not have their hands tied when dealing with critical negotiations that are still coming up in regards to pending health care reform legislation," AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, told AAFP News Now.

Delegates were careful, however, to define the parameters for such a public option, said Moquist, with one resolved clause of the final resolution describing how such an option should work. That resolved stipulates that it is AMA policy "that insurance coverage options offered in a health insurance exchange be self-supporting, have uniform solvency requirements; not receive special advantages from government subsidies; include payment rates established through meaningful negotiations and contracts; not require provider participation; and not restrict enrollees' access to out-of-network physicians."

In addition to the components that the AMA says it will require for its support of any health system reform legislation, the final resolution also specified that the AMA would "actively and publicly oppose" the inclusion of certain provisions in such legislation, including

reduced payments to physicians for failing to report quality data;
redistribution of Medicare payments among providers based on outcomes, quality and risk-adjustment measurements that are not scientifically valid, verifiable and accurate; and
Medicare payment cuts across all physician services to partially offset bonuses paid to physicians in certain specialty fields at the expense of others.

Epperly said the final version of the latter provision softened the original language, which specifically referred to bonuses for primary care physicians. He noted that the AAFP's delegation addressed the house directly about the issue during its deliberations on the measure, advising them that the nation must invest in primary care and the physicians who provide these services "if we are to have a better health care system for our country."

"If we do not better pay primary care doctors, we will not have a primary care system. If we do not have a primary care-based system, we do not have a health care system," Epperly said. "The will of the house (of delegates) was that they didn't want to rob Peter to pay Paul, but they did alter the language and removed 'primary care' from this last bulleted item."

Heim agreed. "We're happy with it (the final resolution). It allows the discussions to continue, so we are pleased with that. But we're not necessarily happy with every single item."