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  • AMSA Supports Dr. Murthy Appointment for U.S. Surgeon General

    AMSA, representing almost 40,000 physicians-in-training in the United States, supports the appointment of Dr. Vivek Murthy for U.S. Surgeon General. Dr. Murthy was a member of AMSA during his medical training.

    Nominated by President Barack Obama, Dr. Vivek Murthy has garnered intense opposition from the National Rifle Association and its supporters for his long-time support of increased gun regulations for private owners in the United States.

    Guns are involved in about 85 deaths each day in this country. Each year, more than 60,000 people suffer nonfatal injuries from guns.

    According to AMSA National President Dr. Nida Degesys, "As the founder of Doctors for America and a former emergency room physician, he has dedicated himself to expanding access of affordable health care and advocating for his patients. The role of the U.S. Surgeon General should be to advocate on behalf of a public health crisis, such as gun violence. With his past experience and insight into the crisis, AMSA believes Dr. Murthy is ready to become ‘the nation’s physician.’”

    AMSA urges the enactment of effective federal violence prevention legislation which calls for a ban on the sale, manufacture, importation, ownership and possession of guns in the United States, except for police, military and hunting purposes. The organization also encourages further studies on violence as a public health emergency.

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  • Video goes viral: U.S. Senate Hearing on Single-Payer System

    The U.S. Senate’s subcommittee on primary health and aging held a hearing with the theme, “What can the U.S. learn about health care from other countries?” Convened by Vermont Senator Bernie Sanders, the hearing featured discussions of health care systems in Canada, Taiwan, Denmark and France. 

    Perhaps the most memorable portion of the hearing was the debate over a single payer system, in which Canadian physician Dr. Danielle Martin faced off against North Carolina Senator Richard Burr. Dr. Martin fields Senator Burr’s questions admirably, and debunks many misconceptions about Canada’s single-payer system that Burr brings up.

    A video of the debate was uploaded onto YouTube by Senator Bernie Sanders, and has since been spread across media sites with the headlines praising Dr. Martin for “schooling”, “smacking down”, and “dropping some serious knowledge on” the Republican senator. Hopefully, the flood of media attention on this single-payer debate will ultimately help persuade Americans to support a single-payer system in the US. In her final response, Dr. Martin makes an important and perhaps disturbing observation about the current U.S. healthcare system:

    North Carolina Senator Burr: On average, how many Canadian patients on a waiting list die each year? Do you know?
    Dr. Martin: I don’t, sir, but I know that there are 45,000 in America who die waiting because they don’t have insurance at all.

    Watch the entire video here:

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  • Physicians switching to salary pay

    By Katie Ni
    AMSA Health Policy Education and Outreach Coordinator


    The current trend for both primary care and specialists has shifted from private practice model and embrace salaried jobs with hospitals. The American Medical Association says that 60% of family doctors and pediatricians, 50% of surgeons, and 25% of surgical subspecialty physicians are employees rather than independent (See graph).



    Hospitals have been offering physicians much more attractive deals than what is traditionally experienced in private practice. Private practice makes less revenue and includes higher risk. It is not surprising to see many physicians making the switch.

    On the surface, the increase in salaried doctors seems like good news for controlling health costs. In reality, physicians in hospitals are rewarded for doing more procedures and prescribing more medicines. This may particularly be the case for doctors who were drawn into hospitals by the competitive pay in the first place.

    It is truly unacceptable for physicians to allow their own financial gain to effect making the best decision for their patients. Some may say that it is human nature, others consider this to be a reflection on character. However, there are two main ways the medical community can improve the situation. The first is to adopt a reward system based on quality of care, rather than quantity of care. Secondly, we must improve the financial burden to medical students. The motivation for financial gain may be related to simply the high cost of becoming a physician. Through recent studies have found that most doctors do not choose specialty based on pay, it remains that many bear large student loans. For some physicians, the love of the job may be enough of a payoff but others may want to see their work pay off financially as well. Addressing problematic healthcare practices is best done by changing the systems and infrastructure under which the incentive problem exists.

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  • Business as usual, the profits of insurance companies and the ACA



    By Whitney McFadden
    AMSA Health Policy Chair


    There are 515 counties in the US with only one insurance option through the online marketplace. Insurers have a business model based on profits that lead to marketing in areas where they will have the most financial success. The economic effects of the Affordable Care Act on the business of private insurance companies are limiting the choices of Americans in poor counties. However many Americans in these areas have higher government subsidies and therefore do not directly feel the financial burden of these higher premiums.

    USC Health Finance Professor Glen Melnick explains that our model of reform does not focus on insuring everyone, but places funds in the hands of insurers who respond to business opportunities. He says, "is it going to continue to be about private insurance markets, or will it be about patients - all patients? An improved Medicare for all would be about the latter."

    Aetna Inc and UnitedHealth Group Inc have focused their provider pool to counties where they believe to turn a profit. They focus on areas of stable employment, high levels of income, and better health environments. "We are very careful to pick the markets where the insurer could succeed" explains Mark Bertolini, Chief Executive of Aetna.

    The evolution of business within the ACA straddles the line of capitalism and controlled markets. The result is a battle of forces both seeking sustainability and growth. In these 515 counties, the government is subsidizing the higher premiums where insurance companies have elevated rates to ensure a profit.

    At the moment, subsidies are providing affordable care for these citizens, however this business model will remain as long as healthcare will continue to turn a profit.

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  • $1.1 trillion spending bill and what it means for healthcare in 2014

    By Katie Ni
    Education & Outreach Coordinator, AMSA Health Policy Team

    Last Thursday, the Senate voted to pass the $1.1 trillion spending bill that will fund the government through this September. The bill passed easily in both the Senate and the House-- perhaps with the memory of government shutdown still fresh in representatives’ minds. Here is the short and sweet version of what this year’s budget has in store for health policy:

    1. Funding for the Affordable Care Act will be cut. The ACA will see cut funding in two places: $1 billion will be cut from Prevention and Public Health Fund, and $10 million will be cut from the Independent Payment Advisory Board (IPAB), the panel given the task of making changes to Medicare payment and program rules. IPAB was made to achieve savings for Medicare, but has been denounced by its critics as a “death panel” that will reduce access to care. A cut of $10 million from the IPAB’s former budget of $15 million may limit the board’s capabilities significantly.

    2. The NIH will recover funding lost from sequestration, BUT overall will see a decrease in funding. The NIH will receive $29.9 billion for 2014, which is $1 billion more than its post-sequestration value, but $714 million less than its original 2013 budget. While the research giant will at least be able to recover funds lost from sequestration, it is discouraging to see the government’s deemphasizing of biomedical research, which works on new vaccines and treatments, curing diseases like cancer and diabetes, and other projects that could profoundly improve human health.

    3. Funding for the FDA and CDC have increased. The FDA will receive $2.6 billion in 2014, a near-$100 million increase from its 2013 budget. The CDC will receive $6.9 billion, $369 million more than its 2013 budget. The FDA regulates food, medication, and other consumer products, while the CDC has an important role in monitoring and preventing diseases. Both will impact the health of a huge number of people based on their ability to carry out these tasks, and hopefully the extra funding will be used efficiently to help these important agencies function in the coming year.

    4. Federal funding is banned from being used for most abortions. The bill also bans foreign aid from being used toward abortions, and funds abstinence-only education in schools. Always a controversial topic, it would appear that the pro-lifers have made several gains through this spending bill. Some health plans available under the ACA could continue to cover elective abortion, but in general, this measure will make it more difficult for women to choose an abortion (for reasons other than rape, incest, or medical emergency), especially for women on subsidized health plans.

    For current and future physicians, the cut ACA funding will be the aspect of the spending bill that has the greatest impact. On paper, the spending decrease on the ACA represents a compromise made between the Republican and Democratic parties; however, in practice, the cut programs—reworking Medicare costs and implementing preventative health programs— are projects that have potential to decrease health expenditures in the future. Choosing to cut them now may translate to a net loss down the road. While it is encouraging to hear that Congress has finally successfully compromised on a budget and avoided a second government shutdown-level crisis, the spending bill represents a mixed bag in terms of health policy.

    Additional information/sources:
    http://www.washingtonpost.com/politics/the-houses-massive-11-trillion-spending-bill-the-posts-guide/2014/01/15/74e7eabe-7e14-11e3-9556-4a4bf7bcbd84_story.html

    http://www.modernhealthcare.com/article/20140114/NEWS/301149970

    http://www.medscape.com/viewarticle/819432

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  • Study Break for the State of the Union Address

    By Whitney McFadden
    AMSA Health Policy Team Chair

    As a medical student, between studying for the next test, preparing for an early morning presentation on rotation, and trying to skillfully hold the stethoscope to hear a heartbeat, I believe the State of the Union is an important opportunity to learn what our President feels are the most salient issues facing our nation. Personally, I was interested in his approach to the issues relevant to many of our patients, wealth disparities in the U.S., the future of our healthcare system, and access to medicine.

    Here are some of the points that stood out and will hopefully continue the discussion of how we can improve our nation’s health:

    A growing number of Americans who would have been without health insurance are now covered. The president spoke about Amanda Shelley, a single mom with a pre-existing condition that prevented her from having health insurance prior to January 1st. She had emergency surgery that would have made her bankrupt had she not enrolled in her new plan created by the Affordable Care Act. President Obama called on every American to help get their family and friends covered and to tap into the collective spirit that moves our nation forward.

    - 3 million young adults under 26 have been covered under their parent’s plan
    - 9 million signed up for private or Medicaid coverage
    - 0 Americans can be dropped for pre-existing conditions

    Other initiatives:
    - Raising the minimum wage to $10.10
    - Leading CEO partnering to reduce long term unemployment (these are many of our chronic patients)
    - ConnectED goal of connecting 99% of students to wireless technology within 5 year partnering with Apple, Verizon, Microsoft, and Sprint
    - Improve access to completion of higher education
    - Call on the house to support the Employment Non Discrimination Act to endorse gender and LGBT equality in the workplace.

    After the address I was left with questions about how immigration reform can improve health disparities provide a secure route to obtaining necessary health services in high need populations. I was also left hoping Obama would address global access to essential medicines as the Fast Track Bill for the Trans Pacific Partnership Agreement currently prioritizes corporate profits over patients. The much needed study break was well served to see how Obama addressed our nations top priorities and addressed the effects from his healthcare initiatives.

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  • How we pay for medical care in 2014: Paying for quality and efficiency



    Whitney McFadden
    AMSA Health Policy Chair


    Bodenheimer and Grumbach outlined in their book, Understanding Health Policy: A Clinical Approach, a view of health policy and the faults of our current healthcare system. It seems we are very familiar with the pitfalls of our current system. In order to be clear and not dwell too much on the obvious, our system struggles with overuse and underinsurance/lack of insurance that is being addressed with the Affordable Care Act. Today we pay for healthcare out-of-pocket, with individual private insurance, employment based private insurance, or government financing. Insurance plans for healthcare began in the depression due to unstable payments. Medicare was established to cover the elderly and lower income individuals. Currently physicians are paid in a multi-tier system including fee-for-service, episode illness grouping, capitation (per head fee to general practitioner and specialist), and salary.
     
    2014 will be a year of new payment methods for healthcare. The sustainable growth rate (SGR) has historically be underfunded requiring congressional intervention to avoid the reduction in payment to medical reimbursement that would make it unsustainable. This year, a bipartisan fix will change payments to value based on measure of better quality and efficiency instead of the current greater volume and intensity of services. Some evidence exists in community clinics that this method has been successful and alternative payment models (i.e. transitional care) have been attempted as possible solutions. McClellan makes the point that we currently do not know how to create a system that is cheaper and rewards improved health outcomes. 

    One solution is single payer healthcare, which addresses the funding source. However our problems with how payments will be made to increase efficiency would still remain. There are methods by which we can change the way our healthcare dollars are spent, but we will not find those solutions on the national stage. Instead, each clinic and hospital must look at their individual patient population, the diseases they treat, and the access to care in the community in order to develop a system that is financially viable. We would benefit from establishing a medical economics team at every health provider institution to allow for individualized services from technologic tools that we know work well. The team based approach to healthcare that is the foundation for our medical training should extent to healthcare funding. Instead of trying to find the rules that would apply to everyone, we need to establish the framework by which everyone can create their rules, and do it with ease, efficiency, and completeness.

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  • My HealthCare.Gov Experience

    Brandon Sandine
    AMSA Local Health Policy Coordinator

    Amidst the media turmoil surrounding the website healthcare.gov, developed to help citizens obtain health insurance through the Affordable Care Act, I decided to try my luck navigating the website and see if the media recounted the experience accurately.

    After opening up the healthcare.gov webpage, I was immediately prompted to click the big orange link to begin the application. The new page that appears after clicking the apply link allowed me to choose whether or not I want to finish the application online or by phone. As my experiment was to determine if the website was functional I chose to finish online. The next steps were to create a profile and provide information to determine my financial eligibility.

    Impressively, when it was all said and done, the entire process did not take more than 15-20 minutes and was incredibly simple. Furthermore, before logging off I knew exactly what type of coverage I was eligible for. My hope with all of this is to inform people who have not applied for health insurance due to website issues to know that they can rest assured that progress has been made. My experience with healthcare.gov was simple, quick and painless.


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  • ACA Coverage and the New Year



    Whitney McFadden
    AMSA Health Policy Chair

    As medical students, what should we expect for our healthcare system this year?

    The Department of Health and Human Services is closely tracking the number of people signing up for health insurance. This year’s resolution will be to follow how Obamacare is improving the health of our nation. First, 2.1 million Americans have signed up for private insurance in the exchanges and a new 3.9 million were found to be able to access coverage through medicaid. We do not know how many people had to change their current insurance, and how this coverage will affect doctor patient visits. In the end, we want to understand how these changes improve the health of our nation.

    How we prioritize and evaluate the measure of our national health will be a significant issue this year. Obamacare is covering more individuals and in order to measure its success, many are searching for ways to see the impact on healthcare. The National Bureau of Economic Research studied the Oregon Health Insurance Experiment published in 2011 to investigate how health insurance improves health care and outcomes. The study measured health care utilization, out-of-pocket medical expenditures, medical debt, and self-reported physical and mental health in randomly chosen low-income participants who qualified for coverage. The study found that those with coverage had statistically significant changes in their health. Participants were likely to have more healthcare utilization (hospitalizations, outpatient visits, prescription medications), less expenses, and better self-reported health. It seems these will be a few of the outcomes to follow after the ACA is in full swing.

    Listed are some of the noteworthy changes for the 2014 year:
    1. Insurance coverage will not be withheld for individuals with pre-existing conditions or premiums elevated based on age or gender.
    2. Insurance companies must share pricing and benefit information with consumers in a comparative way. 
    3. Private exchanges might be used more in the workplace.
    4. Employer mandate set for 2015 will give small companies time to prepare for covering their employees. 
    5. Price transparency. 
    6. Likely more regulations imparted by HHS.
    7. Insurance companies will begin to limit the number of healthcare providers they cover based better rates. 
    8. States will have the most impact on local price structure (i.e. Medicaid expansion). 
    We will likely see some great improvements in care as individuals access more preventive services, get connected with primary care physicians, and pay less for healthcare. However, some changes remain to be seen. Emergency room visits are not likely to drop off if we use the OHSE as a model, and some insurance plans have already increase their premiums to existing customers covering lost costs for sicker people. Following the progress of our healthcare system over the next few years will be essential to improving our health as a nation. As medical students we can help patients be aware of these changes and the effects on our overall healthcare.

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  • Mental Health Parity Act: Re-visted and Re-vamped



    By Whitney McFadden
    AMSA Health Policy Chair

    The Mental Health Parity Act and Addiction Act originally signed in 1996 and expanded by George W Bush in 2008 was established to create equity in health insurance coverage of mental health benefits. The law increased access to care, however many gaps in coverage remained and the laws were not enforced. The law established equal coverage so that co-pays could not be higher for mental health care, there were no differences in the number of visits covered, and the coverage was expanded to substance abuse treatment.

    The preliminary ruling for mental health parity was established in 2010, however over 5,000 comments had to be addressed before the regulations could be put into effect. This process occurred during the introduction of the ACA and requirements for the bill were put on the back burner while the comments were addressed. Some new requirements addressed intermediate care coverage of patients who do not require hospitalization, but cannot be treated as an outpatient. Additionally, the limits on location of care were removed making insurance companies liable for payment if care was found outside the state.

    The Mental Health Parity Act is not predicted to increase health insurance costs and if implemented correctly, will provide more affordable care when patients seek mental health services earlier. This is thought to result in better outcomes, less time in the hospital, and less time lost in the workplace.

    These changes in coverage come at a time when the ACA is transforming the environment for insurance companies. These changes echo the already expanding market for coverage regardless of pre-existing conditions. This “incredibly important law, combined with the affordable care act, will expand and protect behavioral health benefits for more than 62 million Americans” says Kathleen Sebelius, U.S. Health and Human Services Secretary. The new regulations will mirror plans already in place in the ACA and emphasize the importance of comprehensive mental healthcare on our nation’s psyche.

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