AMA advocacy helps score 3 significant wins for patients

On the issues of extending health care coverage for the uninsured, eliminating barriers to treatment for patients with pain and improving maternal health, long-time and persistent AMA advocacy has shown results that will have tangible patient benefits.

“These are some big wins for patients and physicians,” said Todd Askew, the AMA’s vice president of advocacy during a recent episode of "AMA Moving Medicine."

Specifically, AMA advocacy efforts helped achieve the following:

• Fixing the Affordable Care Act (ACA) “family glitch,” which has prevented hundreds of thousands of families from getting financial assistance to buy ACA marketplace coverage.
• Gaining nearly $1 billion in federal funding for programs to enhance maternal health care.
• Revising Centers for Disease Control and Prevention (CDC) opioid-prescribing guidelines to remove barriers to appropriate pain care.

Individuals whose job offered “affordable” health insurance, defined as costing less than 9.83% of their household income, were not eligible for subsidies to help pay for coverage with a plan purchased from the ACA marketplace. But while individual insurance was attainable, family coverage was still out of reach for many who could not afford their employer’s plan and were not eligible for marketplace subsidies.

“You had a lot of people that potentially should have had access to affordable coverage through the ACA who did not because of this interpretation of the statute,” Askew said.

AMA policy called for removal of the family glitch, and he noted that the AMA has urged the last three presidents to do so and the Biden administration has obliged.

“It’s just a further strengthening of the Affordable Care Act’s promise that families will have access to affordable health insurance,” Askew said. “It’s a great thing.”

Learn why the AMA advocated to nix the “family glitch” and make these other ACA fixes.

The CDC’s 2016 opioid-prescribing guidelines included specific limits on dosage and lengths of prescriptions, which some states, insurance companies and pharmacies turned into unbending regulations that failed to accommodate patients whose conditions required higher doses and longer treatment.

“That presented a real dilemma for patients who had real problems with pain that was not addressed by those lower limits or shorter durations,” Askew said. “The AMA has had a very strong voice here in pressing CDC to clarify and to say these are not supposed to be absolute limits—this is general guidance.”

The AMA detailed its concerns in a 17-page letter to the CDC (PDF) two years ago. Agency officials listened and the limits on dosage and duration have been removed from a draft of the revised guidelines.

The CDC also notes that its guidelines should not be “a replacement for clinical judgment or individualized, person-centered care.”

While noting that there’s still considerable work remaining to achieve CDC’s stated goal of supporting individualized patient care determinations, in a letter to the CDC in April (PDF), the AMA commended the agency for recognizing the harms done to patients and physicians by the misapplication of the guidelines and their “rigid numeric thresholds.”

The recently passed Consolidated Appropriations Act, 2022, which funds the federal government for the remainder of its fiscal year included nearly $1 billion for maternal health priorities, including:

• $83 million for safe motherhood and infant health programs at the CDC, including maternal mortality review committees and perinatal quality collaboratives 
• $748 million for block grants to fund programs supporting the health and well-being of mothers, children and families 
• $6.5 million for screening and treatment for maternal depression and related disorders.

“The state of maternal health care in the United States does not stack up very well, quite frankly, to much of the industrialized world,” Askew said. “So we were really pleased the administration and Congress have both been very active in emphasizing support for maternal health programs.”

Find out about AMA advocacy to improve maternal health (PDF).

“AMA Moving Medicine” highlights innovation and emerging issues that impact physicians and public health. Catch every episode by subscribing to the AMA’s YouTube channel or the audio-only podcast version.