AMA 2017: ACA repeal dominates leaders’ speeches

In their two speeches opening the American Medical Association (AMA)’s 2017 meeting in Chicago, CEO James Madara, MD, and President Andrew Gurman, MD, both focused on the efforts to repeal and replace the Affordable Care Act (ACA) with a bill the AMA has actively opposed.

Madara called the AMA’s advocacy work on the American Health Care Act “something really big and incredibly important,” though its opposition didn’t stop the House from passing the bill by a narrow margin in May. The association’s goals remain the same, he said: protecting and expanding insurance coverage, including Medicaid, and strengthening the individual insurance market. Without mentioning any of the major political players, including President Donald Trump, by name, he referred to the uncertainty around healthcare efforts with the current leadership in Washington, D.C.

“We all have to acknowledge the challenging political environment we’re working in. We’re in truly uncharted waters,” he said. “Yet, we will push forward with mission, advocacy and leadership, three words that have defined the AMA over these last 170 years.”

Gurman went even further in his speech, saying 2017 should be a “wake-up call” to physicians who may have doubted the importance of advocacy. He said the AMA’s position isn’t to say the ACA shouldn’t be changed—calling the law “far from perfect”—but to protect patients from losing insurance, which may result for millions under the Republican-sponsored AHCA.

“While we might debate the appropriate ways to fix the ACA, we continue to support the goal of making health care more affordable and accessible for everyone and better protecting patients from the devastating financial costs that can result from a health emergency or serious illness,” he said. “At the AMA, we stand rooted in principles, not politics.”

Gurman then went on to areas where greater agreement across the healthcare industry had been possible, like the association’s opposition to the proposed insurance mergers of Aetna and Humana or Anthem and Cigna. He also mentioned the industry’s response to the proposed timeline for implementing new payment tracks in the Medicare Access and CHIP Reauthorization Act (MACRA), saying the AMA helped “significantly reduce reporting burdens for physicians.”

“Reporting one measure, on one patient to CMS this year is all you need to do to avoid a 4 percent payment penalty in 2019,” he said. “If you report more, you might qualify for a bonus. No one in this room should be hit with a penalty.”

He ended his speech on a more controversial issue: immigration. The effects of limiting H-1B visas for medical professionals has been discussed at the AMA meeting and the association has opposed the Trump administration’s now-blocked order to suspend immigration from seven Muslim-majority countries. Gurman said after that travel ban was first put into place, he met with medical students at Chicago’s Loyola University, who first came to the U.S. as children.

“We talked for more than an hour and, in their voices, I heard fear about the executive action and its potential impact on their lives, their families and their pursuit of medicine,” he said. “I could not imagine being in their shoes, feeling uncomfortable in the country they call home. All I could do was listen and bear witness to their concerns. I reassured them that the AMA was strongly advocating to oppose this order and to support legislation that protected students like them.”

Gurman’s tenure as president comes to an end at the annual meeting. He’ll be replaced by family medicine physician David Barbe, MD, MHA.