From gut-wrenching gun violence to contentious debates over immigration and health care policy and a vital victory for health insurance competition, Andrew W. Gurman, MD, reflected upon an eventful year as AMA president during Saturday’s opening of the 2017 AMA Annual Meeting.
“For our colleagues out there who had not yet realized the importance of advocacy, well, I hope 2017 has been their wake-up call,” said Dr. Gurman, an orthopaedic hand surgeon from Hollidaysburg, Pennsylvania.
As the U.S. Senate deliberates how to proceed on health care reform after the House passed the American Health Care Act (AHCA) repealing and replacing the Affordable Care Act (ACA) over the strenuous objections of physicians, patient advocacy groups and many other stakeholders in medicine, the AMA is obligated to “step up” for its comprehensive vision on health-system reform, Dr. Gurman said.
“Each of us has a crucial role to play in creating a health care system that better delivers for our patients. A system that is accessible and affordable. One that is flexible around their needs. One that is transparent about cost and exists as part of a larger social safety net to keep us living longer, healthier and more active lives,” he said. “Do our patients deserve any less? Of course not! They need as many allies as they can get. They need all of us speaking out on their behalf,” he said.
The Congressional Budget Office has estimated that the AHCA, if enacted, would result in 23 million fewer insured by 2026.
“The ACA is far from perfect and should be improved to stabilize the marketplace and make meaningful health insurance more affordable, but the law did expand coverage to more than 20 million people who were largely unable to obtain insurance in the past, Dr. Gurman said.
“While we might debate the appropriate ways to fix ACA, we continue to support the goal of making health care more affordable and accessible for everyone—and better protecting patients from the devastating financial costs that can result from a health emergency or serious illness.”
Out of horror, a call to act
The first big test of Dr. Gurman’s tenure was the Pulse nightclub shooting, in which a man used a legally purchased semiautomatic rifle and handgun to kill 49 people and injure 58 others. Hours after the shooting, the AMA House of Delegates strengthened its policy to call for a background check and waiting period for all firearms purchases, not just handgun buys. Delegates also adopted policy declaring gun violence a “public health crisis.”
The AMA also signed on to a wide-ranging “call to action” seeking universal background checks on gun purchases, restrictions on the sale of military-style weapons and large-capacity magazines to civilians and more research on how to cut morbidity and mortality involving firearms.
“We later joined the American Bar Association to host a gun-violence prevention summit here in Chicago, a city with more than its share of heartbreak linked to gun violence,” Dr. Gurman said. “The conference brought together local leaders from the medical community, legal community, criminal justice community and others to discuss and collaborate on meaningful solutions that could reduce and perhaps, one day, even prevent gun violence.”
On another issue—the proposed, anticompetitive mergers of four health insurance Goliaths—it was the AMA’s ability to marshal a sweeping collection of 17 state medical associations, leading economists, policy experts, attorneys general and physicians to translate into concrete terms the deals’ potential impact that ultimately won the day in court, Dr. Gurman said.
“In this coordinated, two-year effort, we wrote the Department of Justice and testified before Congress. We lobbied state officials. And, we mined data and stories from the field to build our case that patients—and doctors—are better served in a health care system that promotes open competition and choice.
“Federal judges cited our arguments in their decisions to halt the mergers. And, when all four parties later abandoned their efforts, it brought to a close one of our defining victories in recent years, one that should serve as a model for our collective advocacy work now and into the future.”
Treating the pains of prior authorization
A battle still ongoing but just as critical to patients and physicians is the AMA effort to reform insurers’ prior-authorization requirements.
“The average primary care physician shouldn’t have to waste his or her time with 37 preauthorizations for testing and medication every week,” Dr. Gurman said to loud applause, referencing the findings of a recently conducted survey.
The AMA and 16 other organizations representing physicians, medical groups, hospitals, pharmacists and patients recently set forth a comprehensive set of 21 principles to fix the prior-authorization process, focusing on the need for clinical validity, transparency, fairness, administrative efficiency and more.
“We’re working collaboratively with health plans, benefit managers and others to reduce administrative burdens for both payers and physicians, and to improve the patient experience as well.”
Lighting the way
Dr. Gurman also has reached out to physicians and medical students potentially affected by contemplated changes in immigration policy under the new administration. He has attended listening sessions with medical students who have Deferred Action for Childhood Arrivals status and international medical graduates concerned about the president’s effort to ban travel from six countries.
“I could not imagine being in their shoes, feeling uncomfortable in the country they called home. All I could do was listen and bear witness to their concerns. But I reassured them that the AMA was strongly advocating to oppose this order and to support legislation that protected students like them. This is what our work is about. This is advocacy at its most basic, most human level,” Dr. Gurman said, again sparking a round of applause.
“It is our duty,” he concluded, “to shed light on the challenges that physicians face and to seek changes to protect the profession. Let us shine a light so that others may find their voice and take this journey with us. We are the light that medicine needs, that our profession needs, and that our patients need.”
Read more news coverage from the 2017 AMA Annual Meeting.