AMA House Sends Clear Signal: No to Per Capita Caps on Medicaid

The American Medical Association opposes capping federal Medicaid spending.

At the AMA House of Delegates meeting last month in Chicago, delegates issued a sharp message to Republican lawmakers considering per capita spending limits (or caps) on the federal-state health care program for the poor and working poor: don’t do it.

The recommendation of a report by the AMA’s Council on Medical Services that the AMA “oppose caps on federal Medicaid funding” was adopted as AMA policy by delegates who were all but unanimous that Republican plans for capping the program could be disastrous. “Save Medicaid, save our children,” said John Meigs, M.D., president of the American Academy of Family Physicians, to applause from other House delegates.

Opposition to caps has been a key component of APA’s own message to congressional lawmakers, as it is through the Medicaid program that many of the most seriously mentally ill people receive psychiatric services. “Low-income and uninsured adults have sharply higher rates of serious mental illness compared with those with insurance and higher incomes, which is why the expansion of the Medicaid program under the Affordable Care Act has been so essential,” said APA President-elect Altha Stewart, M.D. “We are very pleased to join the AMA in opposition to per capita caps, which will harm our patients and diminish access to badly needed psychiatric services.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., added, “Medicaid expansion has been especially vital in addressing the opioid epidemic. We know there has been a substantial increase in the use of substance use treatment and in coverage of spending on buprenorphine services in states that have taken advantage of Medicaid expansion. Under a system of per capita capped payments, tens of thousands of individuals struggling with opioid addiction would have been denied Medicaid coverage and treatment. States have significant flexibility in tailoring their Medicaid programs and can be provided more flexibility without capping federal payments.”

A second recommendation in the Council on Medical Services report was also adopted by the House, calling for Congress and the Department of Health and Human Services to “seek and take into consideration input from the AMA and interested state medical associations, national medical specialty societies, governors, Medicaid directors, mayors, and other stakeholders during the process of developing federal legislation, regulations, and guidelines on Medicaid funding.”

The CMS report on Medicaid funding was one of several in which delegates struck back at Republican and White House proposals. The unanimity around opposition to Medicaid caps is also reflective of something obvious to those who have observed the House over decades: this is not your father’s AMA.

With an influx of young physicians—the Medical Student Section and Resident and Fellow Section of the AMA are among the most active and vocal in the House—as well as women and minorities, the demographics and politics of the organization have changed dramatically, becoming markedly more public-health minded. It is noteworthy, for instance, that the House approved studying the feasibility of a “public insurance option” to exist alongside the private insurance industry—something that would not have been conceivable at the AMA a decade and a half ago. (The House also approved resolutions declaring that the AMA would not hold its meetings in states with so-called “gun gag” laws that prohibit physicians from discussing gun ownership with patients or in hotels that do not have gender-neutral bathrooms.)

Actions on Trump ‘Travel Ban’

Mark Moran

Delegates also approved a host of resolutions addressing the immigration status of physicians and patients and the Trump administration’s March 6 Executive Order on immigration, as well as health care in detention facilities for individuals or families that are being deported. The House approved with no dissent a resolution calling on the AMA to “oppose laws and regulations that would broadly deny entry or re-entry to the United States of persons who currently have legal visas, including permanent resident status (green card) and student visas, based on their country of origin and/or religion.”

A six-member educational panel on the subject of physicians, health care, and immigration policy at the AMA meeting agreed that the White House executive order may affect whether aspiring physicians and researchers from other countries will want to come to the United States.

Additionally, the House approved resolutions directing the AMA to do the following:

• Advocate for the health and mental health care of U.S. children in deportation proceedings against their undocumented parents.

• Oppose the expansion of family immigration detention in the United States, oppose the separation of parents from their children who are detained while seeking safe haven, and advocate for access to health care for women and children in immigration detention centers.

• Advocate for protections that prohibit U.S. Immigration and Customs Enforcement (ICE), U.S. Customs and Border Protection, and other law enforcement agencies from using information from medical records to pursue immigration enforcement actions against patients who are undocumented. 

• Issue a public statement urging the ICE Office of Detention Oversight to revise its medical standards governing the conditions of confinement at detention facilities to meet those set by the National Commission on Correctional Healthcare and track complaints related to substandard health care quality.

“The unpredictable stress and isolation associated with detainment have a significant potential to exacerbate and contribute to mental illness,” Laura Halpin, M.D., Ph.D., a first-year psychiatry resident at UCLA and a member of the Resident and Fellow Section, told physicians during a discussion of the issue. “Federal policymakers and responsible agency officials must ensure that detained individuals receive appropriate mental health treatment.” ■