March 8, 2024: State Advocacy Update

In light of the sharp increase in drug-related overdose deaths among pregnant and postpartum individuals, the AMA and Manatt Health released a new report (PDF) with recommendations for state policymakers to improve access to evidence-based care for pregnant and postpartum people.

Recent data shows opioid-related overdoses are now a leading cause of death associated with pregnancy and the postpartum period, with mortality rates rising more than 80% between 2017 and 2020. The AMA urges state agencies and policymakers to carefully review and implement the recommendations contained in the report to address this mounting crisis. 

Key policy recommendations in the report include:

• Supporting access to medications for opioid use disorder (MOUD) given it is the standard of care for opioid use disorder in pregnancy
• Ensuring pregnant and postpartum people are supported and not punished for receiving MOUD
• Improving data collection and state partnerships to ensure equitable access to treatment
• Requiring correctional facilities and judicially supervised diversion programs to provide all justice-involved people with access to MOUD and universal screening 
• Guaranteeing Medicaid coverage and access to pre-release services for all incarcerated people

“The escalating rise of drug-related overdose deaths during and immediately after pregnancy demands that state policymakers act now to improve outcomes for these individuals, newborns, and families,” said AMA President Jesse M. Ehrenfeld, MD, MPH. “Improving evidence-based medical care during pregnancy for patients who have substance use disorders must start with compassion. Some states have started taking a nonpunitive, public health approach to address this crisis, but more needs to be done.” 

Many structural barriers impede access to evidence-based care for pregnant and postpartum people with opioid use disorder. The report includes several examples of states’ forward progress to remove barriers including increasing education and training opportunities to address misconceptions about MOUD use during pregnancy, linking data sets to obtain a comprehensive analysis of racial and ethnic disparities in access to MOUD among pregnant people, and establishing community-based care teams to support pregnant and postpartum individuals coming out of incarceration. 

View the press release.

In a recent letter (PDF) to the Colorado General Assembly, the AMA expressed strong support for HB 24-1003, legislation which would increase access to opioid-overdose reversal medications and availability of harm reduction supplies in school-based settings. 

In the letter, the AMA emphasized serious concerns over the high number of unintentional drug overdose deaths among young people—with illicitly manufactured fentanyl involved in the vast majority of these deaths, and naloxone unadministered in most cases. 

“We are all working to prevent youth and adolescents from using illicit and counterfeit drugs, and while we continue to pursue youth-focused education, prevention, and treatment efforts, we also must advance public health policy to save lives from overdose,” wrote AMA CEO and Executive Vice President James L. Madara, MD. “Naloxone and other opioid-overdose reversal agents can only save lives when it is readily available for use—and it gets used—during an overdose event.” 

Following a mass shooting in Oct. 2023 that left 18 people dead, the Maine legislature is considering a comprehensive package of bills to prevent future firearm-related injuries and deaths. In a letter (PDF) to legislators, the AMA expressed support for the bills and strongly urged passage of the legislation to help save lives: 

• LD 2237—An Act to Strengthen Public Safety, Health and Well-being by Expanding Services and Coordinating Violence Prevention Resources 
• LD 2086—An Act to Amend the Law Governing the Disposition of Forfeited Firearms 
• LD 2224—An Act to Strengthen Public Safety by Improving Maine’s Firearm Laws and Mental Health System 
• LD 2238—An Act to Address Gun Violence in Maine by Requiring a Waiting Period for Certain Firearm Purchase 

The AMA declared gun-related violence a public health crisis in 2016 and advocates for a comprehensive, multi-faceted public health approach to addressing firearm violence. Learn how the AMA advocates to prevent gun violence and to increase gun safety. 

Patients deserve access to safe, effective and evidence-based reproductive and gender-affirming health care services— and third parties should not be able to interfere in decisions between a patient and their physician about whether, when and how to access these services. That is why the AMA supports Rhode Island SB 2262 and HB 7577, which would shield physicians and other health care providers who provide, support or refer patients for reproductive and gender-affirming health care services, as well as patients who seek these services outside their home state.  

“These important protections will help ensure physicians and other health care professionals can continue to put patient care first without fear of interference, retaliation, or legal repercussions elsewhere,” wrote AMA CEO and Executive Vice President James L. Madara, MD, in a letter (PDF) supporting the legislation. With complex and often inconsistent state laws on access to these services, and with half the states now banning or severely restricting access to abortion and/or gender-affirming care, there are significant concerns about legal repercussions for physicians even in states where the full spectrum of these services remains legal. SB 2262 and HB 7577 protect the Rhode Island medical community and their patients against these risks. 

Medicaid coverage in Michigan has been expanded to include self-measured blood pressure (SMBP) devices and clinical services, a move aimed at enhancing patient access and improving patient outcomes related to cardiovascular disease. The AMA has long supported increased insurance coverage of SMBP equipment and services due to the significant positive impact on the treatment and diagnosis of hypertension.   

The AMA and Michigan State Medical Society (MSMS) are working together to inform physicians about these new Medicaid benefits and to encourage the utilization of SMBP for patients covered by Medicaid.  

The AMA's Improving Health Outcomes has long maintained an ambitious goal to improve hypertension control for 5 million patients. To achieve this objective, the AMA actively seeks partnerships with medical societies and organizations to eliminate barriers to care. Recognizing the critical role of SMBP devices in managing blood pressure, the AMA has frequently partnered with state medical associations to expand insurance coverage and ensure more comprehensive access to these devices and related clinical services. 

Physicians interested in exploring the details of Michigan Medicaid policy regarding SMBP benefits can refer to the AMA website. A comprehensive guide on prescribing SMBP for Michigan Medicaid patients is available (PDF). This marks a significant step forward in advancing health care access and quality for Michigan residents covered by Medicaid. 

As states continue with their legislative sessions this year, what trends are emerging related to three key issues affecting patients and physicians: prior authorization, scope of practice and physician wellness? How do all of these topics impact quality and timely delivery of patient care? How are legislators and regulators shifting their approaches to these issues?   

Hear the latest in the most recent Advocacy Insights webinar—moderated by AMA Board of Trustees Chair Willie Underwood III, MD, MSc, MPH—from a panel of AMA attorneys who work hand in hand on these issues and more with state and specialty medical societies. 

• Daniel Blaney-Koen, JD, senior attorney, Advocacy Resource Center, AMA  
• Emily Carroll, JD, senior attorney, Advocacy Resource Center, AMA  
• Kimberly Horvath, JD, senior attorney, Advocacy Resource Center, AMA  
• Michaela Sternstein, JD, vice president, Advocacy Resource Center, AMA 

View the recording.  

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