AMA Comes to Consensus on Achieving Health Equity, Medicaid Waivers, and Other Emerging Issues

During its annual meeting, the American Medical Association (AMA) voted to adopt new policies on a wide range of issues. The AMA’s House of Delegates—made up of physicians, medical students, and residents from every state and medical field—works to create a consensus on emerging issues. Among the policies decided on this year were a stance on lockout provisions in Medicaid, how to achieve health equity, providing access to evidence-based substance use disorder treatment, and more.

With more states applying for Medicaid waivers to modify the program, the AMA has decided its stance on the so-called “lockout” provisions that are being considered. These provisions terminate coverage in Medicaid for a certain amount of time if patients fail to comply with administrative requirements. The AMA has announced its opposition to such provisions, which can cause patients to lose important access to healthcare services.

“Discontinuing healthcare for thousands of our most vulnerable citizens for failure to meet administrative burdens is a cruel, bureaucratic response to our neediest patients,” AMA Board Member William A. McDade, MD, PhD, said in a statement. “As physicians, we recognize that many of our Medicaid patients lead complicated, difficult lives, and we should value empathy over rigid adherence to red tape.”

Regarding health equity, AMA has outlined a framework to reduce and close gaps in health and healthcare across populations in the United States. The AMA acknowledged the many factors that contribute to health disparities and inequities and highlighted the fact that most determinants of health cannot be addressed by physicians alone but must be addressed in collaboration with others.

The AMA framework includes 5 ways to achieve optimal health for all:

• Advocate for health care access, research, and data collection
• Promote equity in care
• Increase health workforce diversity and cultural awareness/competency
• Influence determinants of health
• Voice and model a commitment to health equity

“There are myriad reasons for health disparities and health inequity, including juvenile justice, bias, stereotyping, prejudice and clinical uncertainty, to the fact that chronic diseases like diabetes and hypertension disproportionately affect minority populations,” AMA Board Member Willarda V. Edwards, MD, MBA, said. “We know that overwhelmingly, America’s physician workforce entered the field driven by a desire to help people. By stepping back, cutting through the rhetoric and working collaboratively, we can ensure meaningful access to care for all Americans and improve the health of our nation.”

Finally, the AMA is urging that patients with substance use disorders receive evidence-based treatment by removing prior authorization barriers and ensuring adherence to parity laws. According to the AMA, only 10% of patients with a substance use disorder receive the necessary treatment.

The House of Delegates is encouraging AMA to advocate for legislation ensuring patients have access to all FDA-approved medications or therapies in all settings; work with other organizations, such as the American Hospital Association, to identify best practices to treat opioid use disorder as a chronic disease; and advocate for the expansion of and improved access to evidence-based treatments during pregnancy.

“The AMA wants all physicians to be leaders in the fight against the opioid epidemic,” said AMA President-elect Patrice A. Harris, MD, chair of the AMA Opioid Task Force. “This means they must fight to end stigma surrounding substance use disorder and medication assisted treatment, which has been shown to decrease overdose mortality, reduce transmission of infectious disease, and reduce general health care expenditures.”