AMA Advocacy with Congress
The Affordable Care Act (ACA) is a comprehensive health system reform law that will increase health insurance coverage substantially for the uninsured and implement long overdue reforms to the health insurance market. The new law includes many major provisions that are consistent with AMA policy and hold the potential for a stronger, better performing health care system. While the ACA represents a tremendous step forward on the path toward meaningful health system reform, it is not the last step, but rather the beginning.
The AMA is continuing to work with Congress and the Administration to refine certain provisions in the ACA.
Independent Payment Advisory Board (IPAB)
Letter to Chairman Camp, Ways and Means Committee, supporting H.R. 452, March 7, 2012
AMA letter to Energy and Commerce supporting H.R. 452, February 27, 2012
Letter to Sen. Cornyn supporting S. 668, the "Health Care Bureaucrats Elimination Act", July 6, 2011
Flexible Spending Accounts (FSAs)
The AMA continues to urge Congress to take action to lift the Affordable Care Act's restrictions on tax-preferred accounts, such as health savings accounts, for over-the-counter medicines.
Letter to Sen. Hatch supporting S. 1098, Senate Companion Bill to H.R. 2010
Form 1099 Information Reporting
After House and Senate passage, H.R. 4 was signed into law April 14, 2011. The law repealed an IRS 1099 reporting requirement for businesses that was included in the Affordable Care Act. The provision required businesses, including physician offices, to file a 1099 form with the IRS if the total amount of payments made to another business in exchange for goods and services was $600 or more in a year. The AMA strongly advocated for the repeal of this requirement since the stricter requirements in the provision would have created an expensive reporting burden which would have negatively impacted the operation of businesses, including physician practices.
Comment letter to IRS Commissioner Shulman regarding 1099 Reporting, September 29, 2010
Physician-Owned Hospitals
Letter to Rep. Hastings supporting H.R. 1159, May 9, 2011
Letter to Rep. Sam Johnson supporting H.R. 1186, May 9, 2011
The AMA continues to be concerned about increasing health plan consolidation, as well as the regulatory barriers that restrict physicians' ability to work together, and has made improving the antitrust environment for physicians a top priority. The AMA is actively supporting H.R. 1409, the "Quality Health Care Coalition Act of 2011," which was introduced by Representative John Conyers (D - MI). H.R. 1409 would allow health care professionals to jointly negotiate with health plans regarding terms that affect patient care, enabling physicians to advocate for quality care for their patients and reinforcing the patient-physician relationship.
On April 20, 2011, AMA sent a letter to Chairman Rehberg of the House Approps. Subcommittee on Labor-HHS, Education and Related Agencies sharing its views on funding priorities for various health programs under the subcommittee's jurisdiction, including those that are crucial to ensuring an adequate supply and distribution of physicians.
The AMA has long held that the central principle of balance—between preventing controlled substance abuse, trafficking, and diversion and ensuring access to necessary pain medication—should guide policy makers as they craft solutions to address these complex problems. The AMA has strongly supported voluntary education tailored to the specific needs of prescribers as well as passage and full-funding of a program that funds state adoption of prescription drug monitoring programs. A key tool in combating diversion is ensuring that physicians have patient specific information at the point of care. While many states have now adopted prescription drug monitoring programs, very few make information available to physicians in real-time at the point of care. Passage of H.R. 866, "National All Schedules Prescription Electronic Reporting Reauthorization Act of 2011" (NASPER 2011) and full funding would establish and modernize existing state-based prescription drug monitoring programs, thereby preserving this critical balance and providing physicians with a basic tool to make treatment determinations based on patient-specific needs. The AMA also supports passage of H.R. 2939, the “Pharmaceutical Stewardship Act of 2011,” which would help combat diversion of prescription drugs as well as to safeguard drinking water from pharmaceutical contaminants. If made law, H.R. 2939 would establish an infrastructure to ensure that patients and physicians have a safe means of disposing of unused prescription drugs on a regular basis and at a time and place convenient to them, which would replace the current take-back programs that only occur periodically each year.
In light of the impending expiration of the Prescription Drug User Fee Act (PDUFA) in September 2012, Congress is expected to enact the fifth PDUFA reauthorization in June. There are a number of legislative proposals attached to the reauthorization on which we have submitted comments, including language that would address drug shortages and provide incentives for the development of next generation antibiotics.
Drug shortages, particularly with respect to generic sterile injectable drugs, have nearly tripled since 2005, hitting a record high last year and forcing physicians to delay or alter patient care. The AMA is actively supporting H.R. 2245, the "Preserving Access to Life-Saving Medications Act," which was introduced by Rep. Diana DeGette (D-CO). The bill would provide authority for the Food and Drug Administration (FDA) to require all drug manufacturers to notify it about impending drug shortages. It would also direct the FDA to find ways to notify hospitals and physicians of shortages as appropriate and in a manner that would minimize hoarding. The Senate companion bill, S. 296, was introduced by Sen. Amy Klobuchar (D-MN). Additionally, the Energy and Commerce Health Subcommittee held a hearing on the issue on September 23, 2011 and again on February 9, 2012 seeking to find ways that Congress could help resolve the problem. The full committee is expected to consider the issue later this year.
Drug Shortages letter to E & C Chair and Ranking Member, April 6, 2012
Drug Shortages ASHP-generated sign-on letter to E&C and Senate HELP, March 16, 2012
The AMA has called on Congressional Leadership to stop the required implementation of ICD-10 scheduled for October 1, 2013. The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient care, and compete with other costly physician practice transitions underway today associated with quality and health IT programs.
The AMA continues with efforts to advance federal legislation on medical liability reforms, including H.R. 5, the Help Efficient, Accessible, Low-cost Timely Health Care (HEALTH) Act of 2011 and H.R. 816, the Provider Shield Act of 2011. H.R. 5 includes time tested reforms similar to reforms in California and Texas such as caps on non-economic damages. In addition, the AMA is supporting H.R. 3586, the "Good Samaritan Health Professionals Act," which would ensure that health care professionals who wish to volunteer their services during a federally-declared disaster have adequate liability protections.
Rep. Tom Price, MD introduced H.R. 1700, the Medicare Patient Empowerment Act, on May 3, 2011. This bill, in line with AMA policy, would allow Medicare patients and their physicians to enter into private contracts without penalty to either party. On May 22, Sen. Lisa Murkowski (R-AK) introduced S. 1042, the Medicare Patient Empowerment Act, in the Senate.
As the leading force in Washington for Medicare reform, the AMA continues to advocate for replacement of the flawed Medicare physician payment formula. In this effort, the AMA is aggressively working with Congress and federal agencies to improve the Medicare program by repealing the sustainable growth rate (SGR), enacting stable, adequate annual Medicare physician payment updates, and ensuring beneficiaries’ continued access to care. The AMA has recommended to Congress a three-pronged approach to reforming the physician payment system:
- repeal the SGR;
- implement a five-year period of stable Medicare physician payments; and
- transition to an array of new payment models designed to enhance care coordination, quality, appropriateness and costs.
Sign-on letter to Conferees re: SGR Repeal, January 23, 2012
Letter to Physician Members of the Doctors Caucus urging SGR Repeal, November 17, 2011
Sign-on letter to Deficit Reduction Committee urging repeal of the SGR, November 10, 2011
Beneficiary-Provider letter to Congress, October 20, 2011
Sign-on Letter to MedPAC on SGR, October 3, 2011
W&M Testimony, "Expiring Medicare Provider Payment Policies," September 21, 2011
Sign-on letter to Sen. Murray, Joint Select Committee on Deficit Reduction, September 20, 2011
Sign-on letter to Rep. Hensarling, Joint Select Committee on Deficit Reduction, September 20, 2011
Sign-on letter to President Obama to repeal the Medicare Sustainable Growth Rate, June 27, 2011
E&C Testimony, "The Need to Move Beyond the SGR," May 5, 2011
Letter to the Senate urging elimination of the SGR, March 10, 2011
Letter to the House urging elimination of the SGR, March 10, 2011
The AMA believes that conditioning physician licensure on participation in any public or private insurance plans unduly restricts a physician's freedom to practice. The AMA is actively supporting H.R. 969, the "Medical Practice Freedom Act of 2011," introduced by Representative Tom Price (R - GA), which would ensure that physicians are not required to participate in any health plan as a condition of licensure in any state.
Letter to Rep. Price supporting H.R. 969, the "Medical Practice Freedom Act of 2011," March 14, 2011
The AMA continues with efforts to address physician workforce shortages and strongly supports stable, adequate funding for graduate medical education (GME) training positions to address the problem. To this end, AMA partnered with multiple medical specialty organizations calling on the Joint Select Committee on Deficit Reduction to protect existing Medicare financing for GME. In addition, the AMA is actively supporting S. 1627, the “Resident Physician Shortage Reduction Act of 2011," which would increase the number of Medicare-supported training positions for medical residents by 15 percent over five years. In addition, the AMA supports the permanent reauthorization of the J-1 visa waiver program which would provide incentives for international medical graduates to practice in medically underserved areas.
Letter to Sen. Conrad supporting S. 1979, the "Conrad State 30 Improvement Act," January 3, 2012
AAMC sign-on letter to Super Committee regarding potential GME cuts, October 3, 2011
Letter to Senate HELP Committee re: S. 958, Senate Companion Bill to H. R. 1852, July 27, 2011
The AMA is a strong opponent of section 511 of the Tax Prevention and Reconciliation Act of 2005 (TIPRA). Under this provision, federal, state and local government entities are required to withhold 3 percent of all payments made for services or property after December 31, 2011, including payments under the Medicare program. The AMA strongly opposes section 511 and we support repeal of this provision.
On October 27, 2011, the U.S. House of Representatives passed H.R. 674, AMA-supported legislation that prevents a planned 3% tax-withhold for many Medicare payments, by a vote of 405-16. The Senate passed this legislation on November 10 by a vote of 95 to 0.
The legislation was signed into law by President Obama on November 21, 2011 and completely repeals this provision of law and eliminates the planned withholding. The cost of this repeal was offset by a change in the definition of Medicare Adjusted Gross Income for the calculation of eligibility for Medicaid or insurance subsidies under the Affordable Care Act. This modification was supported by a majority in Congress and the White House.
This represents a significant victory for physicians and a step forward in stabilizing the Medicare system. The additional burden of a 3% tax-withhold would have been untenable in the current Medicare payment environment.
Letter to Ways and Means Chairman Camp in support of H.R. 674, October 12, 2011
Government Withholding Relief Coalition Letter to the U.S. Senate, June 9, 2011
The AMA strongly supports efforts to ensure that patients have accurate information regarding the education, training, and qualifications of individuals providing their health care services. The AMA is advocating in support of H.R. 451, the "Healthcare Truth and Transparency Act of 2011," introduced by Representatives John Sullivan (R - OK) and Representative David Scott (D - GA), which would provide much needed resources and clarifications to address patient confusion in the health care marketplace.
