AMA on Obamacare: Improve it, don't destroy it

June 14, 2019

The AMA says that the Affordable Care Act must be strengthened to meet the needs of patients who still lack insurance

The American Medical Association (AMA) believes that the Affordable Care Act (ACA) must be strengthened to meet the needs of patients who still lack insurance.

In a policy recommendation released during the AMA’s annual meeting, the organization called the ACA “imperfect” and said that future improvements must be targeted to providing coverage for the uninsured.

But the AMA’s recommendations are not as drastic as those called for by some physician groups. For example, in an apparent pushback on calls to scrap the ACA in favor of a “Medicare for all” plan, the AMA said incremental improvements are preferable to “upending the health insurance coverage of most Americans, including the more than 156 million enrolled in employer-sponsored coverage.”

The AMA also does not recommend creation of a public option in areas of the country lacking insurers participating in the healthcare exchanges. Other physician groups, such as the American College of Physicians, have recommended creation of a public option.

The AMA recommends:

  • increasing the amount of and expanding eligibility for premium tax credits,

  • increasing amounts of cost-sharing reductions received by individuals who qualify for them and

  • extending eligibility for cost-sharing reductions beyond 250 percent of the federal family poverty level.

“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, MD, in a news release. “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.” 

The AMA had previously put forward a policy proposal that the group says would result in coverage to millions of the uninsured. The core tenets of that policy are:

  • Individuals 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 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,” McAneny said. “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.”