TARRANT COUNTY PHYSICIAN (33)
March/April 2021
2. People eligible for Medicaid or the
Children’s Health Insurance Program
(CHIP) who remain uninsured.
3. People that remain uninsured who
are ineligible for ACA’s premium tax
credits.
4. People with low incomes that remain
uninsured and are ineligible for
Medicaid.
Nearly 60 percent of nonelderly
Americans have employer-sponsored
health insurance coverage, 22 percent
have Medicaid coverage, and 7 percent
have non-group coverage. In 2018, 27.9
million nonelderly individuals (10.4 percent)
were uninsured, an increase from the 27.4
million (10.2 percent) who were uninsured
in 2017.
The AMA believes that proposals to
cover the uninsured need to include
provisions to improve health insurance
affordability, including for those who have
difficulties affording their deductibles and
other cost-sharing responsibilities, and
individuals and families whose employersponsored
coverage is unaffordable.
The following is a summary of AMA
policies approved by our House of
Delegates over the years to improve the
ACA:
• The AMA supports adequate funding
for and expansion of outreach efforts
to increase public awareness of ACA’s
premium tax credits.
• The AMA supports increasing the
generosity of premium tax credits
to improve premium affordability
and incentivize tax credit eligible
individuals to get covered
• The AMA supports providing
enhanced premium tax credits to
young adults.
• The AMA supports expanding the
eligibility for and increasing the size of
cost-sharing reductions.
• The AMA supports Medicaid
expansion in all states but does not
ne question I’m
asked frequently
in my role as
AMA President is,
“Why did the AMA
support the ACA?”
The American
Medical Association (AMA) has long
advocated for health insurance coverage
for all Americans, as well as pluralism,
freedom of choice, freedom of practice,
and universal access for patients. The
AMA remains committed to improving
health insurance coverage and health care
access so that patients receive timely,
high quality care, preventive services,
medications, and other necessary
treatments. In 2021 and beyond, steps
must be taken to cover the uninsured and
improve affordability so our patients are
able to secure reasonable and meaningful
coverage with access to the care that they
need.
As millions of Americans have gained
coverage because of the Affordable Care
Act (ACA), progress has been made
on a long-standing policy priority of the
AMA—expanding access to and choice
of affordable, quality health insurance
coverage. Instead of abandoning the ACA
and threatening the stability of coverage
for those individuals who are generally
satisfied with their coverage, the AMA
believes that now is the time to invest not
only in fixing the law but also in improving
it. Improving the ACA targets providing
coverage to the uninsured population
rather than upending the current health
insurance coverage of many Americans.
Modifications to the law could also improve
the affordability of coverage for those who
cite cost as a barrier to accessing the
care they need. Throwing out the ACA
completely would destabilize our health
system at a time when we can ill afford it.
The AMA’s plan to cover the uninsured
and improve affordability focuses on four
main targets:
1. People eligible for ACA’s premium tax
credits who remain uninsured.
support work requirements.
• The AMA supports eliminating the
subsidy “cliff,” thereby expanding
eligibility for premium tax credits
beyond the 400 percent Federal
Poverty Level.
• The AMA supports lowering the
threshold that determines whether an
employee’s premium contribution is
“affordable,” allowing more employees
to become eligible for premium tax
credits to purchase marketplace
coverage.
• The AMA opposes the sale of health
insurance plans in the individual and
small group markets that do not
guarantee: a) preexisting condition
protections; and b) coverage of
essential health benefits and their
associated protections against annual
and lifetime limits, and out-of-pocket
expenses, except in the limited
circumstance of short term duration
insurance offered for no more than
three months.
What about the so-called “public option”
that many expect the Biden Administration
to support as a means of increasing
coverage of the uninsured? There is no
proposal as of yet, but the AMA House
of Delegates in November 2020 passed
a policy that would support a public
option only with very strict guardrails,
e.g., eligibility for premium tax credits to
purchase the public option should be the
same as currently exists for private ACA
marketplace plans—they should compete
on an even playing field. Similar to what
is experienced with private health plans,
payment rates under any public option
need to be established through meaningful
negotiations and contracts. Physician
freedom of practice must be maintained,
and public option proposals should not
require physician participation. Public
options also should be financially selfsustaining
and not receive advantageous
government subsidies compared to other
health plans.
O
THE AMA AND THE ACA by Susan Rudd Bailey, MD - AMA President
From the AMA