A public option needs standards

We will likely hear the term "public option" with greater frequency after Joe Biden takes office, and such efforts continue to gain momentum on the state level. While a public option could expand options for the uninsured population, "It should not be used to replace private insurance; rather, it can be used to maximize competition," AMA president Susan R. Bailey, MD, stated. "With appropriate guardrails, the AMA will examine proposals that would provide additional coverage options to our patients."

The AMA outlined a list of standards a public option must meet to earn its support, including:

• Eligibility for premium tax credit and cost-sharing assistance to purchase the public option is restricted to individuals without access to affordable employer-sponsored coverage that meets standards for minimum value of benefits.
• Physician payments under the public option are established through meaningful negotiations and contracts. Physician payments under the public option must be higher than prevailing Medicare rates and at rates sufficient to sustain the costs of medical practice.
• Physicians have the freedom to choose whether to participate in the public option.
• The public option is financially self-sustaining and has uniform solvency requirements.
• The public option does not receive advantageous government subsidies in comparison to those provided to other health plans.
• The public option shall be made available to uninsured individuals who fall into the "coverage gap" in states that do not expand Medicaid.

HDHPs are harming consumers

At its meeting, AMA council members discussed the impact HDHPs are having on patient care. While such insurance plans have led to an increase in health care spending, it's often at the expense of short-term preventive care and services. The pandemic has only increased financial pressure on consumers, leading to further delay of essential care.

"The pandemic has prominently displayed the critical barriers posed by underinsurance, with many health plans not providing affordable coverage for services to treat chronic conditions and COVID-19- related illness," said AMA Board Member Mario E. Motta, MD.

The AMA suggested the following policy changes aimed at employers:

• Provide robust education to help patients make good use of their benefits to obtain the care they need.
• Take steps to collaborate with their employees to understand employees' health insurance preferences and needs.
• Tailor their benefit designs to the health insurance preferences and needs of their employees and their dependents.
• Pursue strategies to help enrollees spread the costs associated with high out-of-pocket costs across the plan year.

Drug shortages threaten to create a public health crisis

The high cost of prescription drugs has been an ongoing problem in our country for decades, overshadowing another important issue: access to critical drugs. The AMA warns that the pandemic has further disrupted our supply chain and will exacerbate the issue going forward.

"Shortages of critical drugs can have a major impact on patient health," said AMA immediate-past board chair Jesse M. Ehrenfeld, M.D., M.P.H. "That's why it's essential for physicians to have access to the right drugs in order to provide high-quality care for our patients."

The AMA warned that central nervous system medications, antimicrobials, cardiovascular medications, ophthalmic and chemotherapy agents, in particular, are in short supply. The AMA doubled down on a list of policy recommendations intended to address drug shortages, including offering greater incentives for manufacturers to adopt higher quality standards and better manufacturing techniques.

Stay home for the holidays!

The AMA is not alone on this one, releasing a statement in conjunction with the American Hospital Association and the American Nurses Association, all of which are the burden of our overstressed health care system.

"Throughout the pandemic, COVID-19 spread has followed a similar pattern around holidays and mass gatherings," they write in an open letter. "Positive cases spiked after Memorial Day, after the Fourth of July, after Labor Day, and now – two weeks after Halloween. The record-shattering surge underway is resulting in uncontrolled community spread and infection that has already overburdened health systems in some areas and will ultimately consume capacity of our health care system and may reduce the availability of care in many places in our country.

"In the strongest possible terms, we urge you to celebrate responsibly. We are all weary and empathize with the desire to celebrate the holidays with family and friends, but given the serious risks, we underscore how important it is to wear masks, maintain physical distancing and wash your hands."

Read more: 

• 4 charts tracking HDHP, HSA availability among employers
• Hospital drug shortages send prices soaring
• Nearly half of Americans have delayed medical care due to COVID-19