Advocacy Update

July 22, 2022: State Advocacy Update


In a recent letter (PDF) to U.S. Department of the Treasury and the U.S. Department of Health and Human Services (HHS), the AMA stated support for Washington state’s Section 1332 waiver application to allow all qualifying low-income Washington patients, including undocumented immigrants, to benefit from the state’s new premium assistance program to purchase marketplace coverage.

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Covering the uninsured and improving health insurance affordability have been long-standing goals of the AMA, and the approval of this waiver application will advance those goals in Washington State.  

Nationally, lawfully present and undocumented immigrants are more likely to be uninsured than citizens. With federal constraints in place limiting undocumented immigrants from accessing marketplace coverage without a waiver, states can consider taking action to expand access to high-quality and affordable health insurance coverage for this population. 

Moreover, approval of this application will not only expand access to comprehensive health insurance for the nearly 100,000 uninsured immigrants who are currently ineligible for Medicaid or marketplace coverage because of their immigration status in Washington state but it is likely to increase enrollment of family members who may have different immigration statuses and are eligible for Medicaid or subsidized marketplace coverage as well. 

The AMA appreciates efforts (PDF) by the National Association of Insurance Commissioners’ (NAIC) Health Innovations (B) Working Group (Working Group) in studying mechanisms to resolve disparities by improving access to care. Ensuring equitable access to health care is one of the AMA’s top priorities and the AMA believes the NAIC has a unique role in bringing insurance commissioners together to identify actionable solutions that can lead to real change at the state level. The AMA is encouraged by the findings summarized in the memo to the Members of the Special (EX) Committee on Race and Insurance (Special Committee), specifically related to telehealth and alternative payment models, and provided comments on each area for further consideration.   

Telehealth: The AMA strongly agrees with the Working Group’s sentiment that telehealth has the promise to alleviate and break down barriers to access. The Working Group appropriately identified some of the leading barriers to health equity which can be ameliorated with telehealth, including physical access to care and access to culturally competent care. The Working Group aptly identified challenges and limitations to telehealth usage, and the AMA provided comments and additional solutions on the topics of access to care, cost-sharing, culturally competent care, and broadband access, privacy and digital literacy.  

Alternative payment models (APMs) and value-based payments (VBPs): The AMA appreciates that the Working Group is addressing both the potential of APMs and VBPs to address health disparities, as well as the fact that some models can exacerbate such disparities. The Working Group also recognized the importance and limitations of risk adjustment mechanisms. The AMA offered examples of additional proactive measures that may be of interest to regulators, which include ensuring adequate resources and funding, investment in care transformation and physician engagement.  

For more information, read the full letter (PDF).

“Supporting physicians’ and medical students’ mental health and wellness is essential to supporting our nation’s health,” said AMA President Jack Resneck Jr., MD, in an updated issue brief (PDF) on physician health and wellness from the AMA’s Advocacy Resource Center. Improving physicians’ mental health and reducing physician burnout is one of the five key pillars of the AMA Recovery Plan for America’s Physicians.   

The updated issue brief provides model legislative language and other recommended policy actions. Updates include new provisions from Arizona’s recently passed law to support physician wellness (H.B. 2429). These provisions augment those from state laws previously established in Virginia, South Dakota and Indiana that are specifically intended to protect physicians seeking help with career fatigue and wellness.

“After speaking with hundreds of physicians and others in healthcare, we realized physicians and other healthcare workers needed access to confidential mental health resources. The Medical Society of Virginia (MSV) pursued the necessary legislative changes, and then implemented the SafeHaven program that is quite literally saving lives,” said Melina Davis, MSV Executive Vice President and CEO. “This is one of the most important things the medical society has ever accomplished, and is making a real difference for our physicians and their teams.”  

The updated brief also includes new and additional AMA resources for physicians seeking support for health and wellness, as well as medical societies hoping to implement their own physician wellness programs. For more information, view the full issue brief (PDF).