Medicare & Medicaid

Physicians oppose harmful changes to Medicaid, benefits rules

Andis Robeznieks , Senior News Writer

With the adoption of new policies, the AMA opposed Medicaid work requirements, the removal of categories from the essential health benefits (EHB) package and waivers of EHB requirements that could lead to the elimination of EHB categories and their associated protection against annual or lifetime benefit limits and out-of-pocket expenses.

The new Medicaid- and health reform-related policies were included in one report from the AMA Council on Medical Service and a resolution that were presented at the 2017 AMA Interim Meeting in Honolulu.

The resolution was introduced by the Medical Student Section of the AMA House of Delegates (HOD) and calls for opposing work requirements as a criterion for Medicaid eligibility. The reference committee that heard testimony on the resolution described it as “incredibly timely” because eight states have submitted waivers to the Centers for Medicare & Medicaid Services (CMS) seeking to implement Medicaid-work requirements.

In testimony on the resolution, data were provided that indicate nearly 80 percent of Medicaid adults are in working families and almost 60 percent are working themselves. The effect of Medicaid work requirements, it was said, would be to increase administrative costs and burdens on states as well as documentation burdens on a vulnerable population. Delegates raised concerns that imposing Medicaid work requirements would cause some people now covered by Medicaid to lose their health insurance.

Of non-elderly adult Medicaid beneficiaries, 35 percent cite an illness or disability that prevents them from working, 28 percent report that they are taking care of their home or family, 18 percent are in school, 8 percent are looking for work, 8 percent are retired, and only 3 percent of adult beneficiaries outside of those categories are not working or actively seeking employment.

The council report on essential health benefits was also described as “incredibly timely” as several legislative proposals considered in Congress this year included provisions that would allow for EHB changes, such as allowing states to waive essential health benefits. These approaches “could have caused a significant number of Americans to lose access to affordable health insurance coverage,” according to the reference committee’s summary of testimony.

“Most costs associated with EHB requirements are attributable to such services as hospital inpatient and outpatient care, physician services and prescription drugs. These services are fundamental components of health insurance coverage,” said AMA President David O. Barbe, MD, MHA. “Removing any categories from the EHB requirements, or allowing waivers of such requirements, could make individuals vulnerable to significant out-of-pocket expenses, or hinder patient access to necessary services.”

Read more news coverage of the 2017 AMA Interim Meeting.