CHICAGO — The American Medical Association (AMA) reaffirmed its commitment today to covering the uninsured by supporting critical improvements to the Affordable Care Act (ACA).

The policy recommendations -- adopted by the House of Delegates at its Annual Meeting -- originated in a report that noted “the ACA is not broken, but it is imperfect.” An improved ACA would emphasize providing coverage to the uninsured population, rather than upending the health insurance coverage of most Americans, including the more than 156 million enrolled in employer-sponsored coverage.

“Since the ACA was enacted into law in 2010, millions of Americans have gained health insurance. The policy question now is how to improve the law to insure even more,” said AMA President Barbara L. McAneny, M.D.  “We need policies to make coverage more affordable for millions of Americans – both in the premiums they pay, as well as their cost-sharing responsibilities.” 

As such, the AMA’s House of Delegates adopted the following new policies:

• Increasing the amount of and expanding eligibility for premium tax credits, including removing the “subsidy cliff;”
• Increasing amounts of cost-sharing reductions received by individuals who qualify for them; and
• Extending eligibility for cost-sharing reductions beyond 250 % of the family poverty level.

The report raised concerns about the recent uptick in the uninsured rate, as well as future coverage impacts of zeroing out the federal individual mandate penalty, the expanded availability of short-term limited duration plans, and other proposals that have been put forward that could undermine the progress made in covering the uninsured. Expanding health insurance coverage and choice have been long-standing goals of the AMA. The AMA’s health system reform proposal -- the result of 20 years of policy development.

Before today’s vote, the AMA had extensive policy that would result in coverage to millions of the uninsured and believes that:

• Individuals caught in the “family glitch” and unable to afford coverage offered through their employers for their families should become eligible for ACA financial assistance based on the premium for family coverage of their employer plan.
• Young adults facing high premiums should be eligible for "enhanced" tax credits based on income.
• A permanent federal reinsurance program should be established to address the impact of high-cost patients on premiums.
• Initiatives to expand Medicaid programs in additional states should be supported. To incentivize expansion decisions, states that now expand Medicaid should still be eligible for three years of full federal funding.
• To maximize coverage rates, the AMA will continue to support reinstating a federal individual mandate penalty, as well as state efforts to maximize coverage, including individual mandate penalties and auto-enrollment mechanisms.
• To improve coverage rates of individuals eligible for either ACA financial assistance or Medicaid/CHIP but remain uninsured, the AMA would support investments in outreach and enrollment assistance activities.

“The AMA is pursuing sustainable, practical solutions. Building on the ACA would help cover the uninsured without disrupting the coverage of most of Americans. We will continue to put our patients first as we engage in these debates moving forward,” McAneny said.

The AMA acknowledged that equitable access to medical care is a core component of a basic human right to health care, and the AMA holds that physicians have an ethical responsibility to ensure that all persons have access to needed care. There are many pathways to providing patients with equitable access to medical care and the AMA support a pluralistic approach to ensure that all people have access to health care.