Dr. Vernon Rowe is a member of the AMA House of Delegates, representing the American Society of Neuroimaging. Many members of the AMA still doubt that Obamacare, or The Affordable Care Act, will succeed in the long run. They believe that the driving force behind the act was good (to guarantee health care for all Americans), but its implementation has left much to be desired, so that the negative unintended consequences of Obamacare may outweigh the positive.
Some believe the Act will become just one more “unfunded mandate” to states, who will once again have to shrink their Medicaid rolls when federal deficits once again spiral out of control as they are forecast to do in 2018. And those states who took the Medicaid expansion will be in the same position as Missouri was a few years ago, when then Governor Blount had to trim those rolls.
We believe the ACA, with its vast bureaucracy and unproven care delivery experiments like ACO’s, did little to stem what we believe is the major cost driver in healthcare expenditures: the drive toward hospital-dominated, expensive health care delivery, at the expense of patients, insurers, and independent doctors.
The American Medical Association is generally a very democratic group, and when the full organization convenes each year a great deal of intense debate occurs. When the AMA takes or changes a position on an issue in medicine, it is not done lightly. Therefore, the resolutions that came out of last year’s meeting are important in stating the position of the AMA regarding policies across medicine at every level, from hospitals and doctors’ practices up to federal policymakers.
The AMA did, at one time, officially support the Affordable Care Act, in spite of the fact that many aspects of the ACA did not embody principles that were already fully stated in AMA policy and in House of Delegates resolutions leading up to its passage. That support is waning among many AMA members. The initial support of the AMA was conditional, predicated on certain promised changes being made to the ACA. But the promised changes were not made.
The full text of Resolution 231 in bold, as amended by the HOD on June 18, 2013, with the author’s interpretation in (parentheses):
RESOLVED, That our American Medical Association develop a policy statement clearly stating this organization’s policies on the following aspects of the Affordable Care Act (ACA) and healthcare reform:
- Opposition to all P4P (pay for “performance,” or paying for not delivering care, like the HMO’s of the 80’s and 90’s) or VBP that fail to comply with the AMA’s principles and guidelines. (AMA Policy: “ Our AMA continues to advocate to achieve needed reforms of the many defects of the federal Patient Protection and Affordable Care Act (PPACA) law so as to protect the primacy of the physician-patient relationship.”)
- Repeal and appropriate replacement of the SGR (sustainable growth rate, that gets rescued every year by Congress)
- Repeal and replace the Independent Payment Advisory Board (death panel) with a payment mechanism that complies with AMA principles and guidelines. (Once appointed by the President the IPAB is accountable to no one, neither the President nor Congress, and its decisions are not subject to judicial review. This is most likely unconstitutional, but it would take years for the case to reach the Supreme Court. See also this Wall Street Journal article about the unconstitutionality of the IPAB. )
- Support for Medical Savings Accounts, Flexible Spending Accounts, and the Medicare Patient Empowerment Act (“private contracting”)
- Support steps that will likely produce reduced health care costs, lower health insurance premiums, provide for a sustainable expansion of healthcare coverage, and protect Medicare for future generations
- Repeal the non-physician provider non-discrimination provisions of the ACA (Doctors become equal to nurses in the ACA); and be it further
RESOLVED, That our AMA immediately direct sufficient funds toward a multi-pronged campaign to accomplish these goals, and be it further
RESOLVED, That there be a report back at each meeting of the AMA HOD (House of Delegates)
So the jury’s still out on Obamacare. Many believe the negative unintended consequences of Obamacare will far outweigh the positive. Many believe the ACA poured gasoline on the fire of a failed system of healthcare delivery, and enabled even more domination of healthcare by consolidated hospital systems and their owners, at the expense of patients and independent doctors. Time will tell whether Obamacare will result in better access to care for our nation’s needy, or make it even harder for them to obtain care from qualified doctors, and in the end be just one more federal fix for what is really a local problem.
