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  • U.S. Medical Students Willing to Contribute to Health Care for All

    Even after the improvements in coverage due to the Affordable Care Act, over 23 million in the United States will likely remain uninsured, and tens of thousands may die needlessly. A recent survey of U.S. medical students, published in PLoS, published last month, suggests the coming generation of physicians believes in health care for all, and is willing to do their part to achieve this goal. The survey, which included nearly 900 medical students at ten U.S. medical schools, reported that over 86% of medical students agreed or strongly agreed that healthcare should be provided to all regardless of ability to pay. Two thirds (66%) of students indicated they were willing to sacrifice future time and money to provide that care, and nearly three quarters (72%) indicated a preference for a publicly-funded healthcare system.

    In a departure from previous studies that have shown a decline in student empathy over the four years of medical school training, these survey also found that this willingness to sacrifice in order provide care increased with increasing student age and years in medical school, and was also correlated with choosing a primary care career focus.

    There was no consensus about whether "a publicly-funded national health program would solve the United States health care problems," (approximately 1/3 agree, 1/3 neutral, 1/3 disagree), while only 19% supported private health insurance (19% vs 35% neutral, 46% against).

    These results point out an encouraging trend among future students, and the authors suggest a need for increased training in social medicine at medical schools to promote underserved care.

    Read the entire survey here.

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  • AMSA Speaks to HHS on Essential Health Benefits

    Colin McCluney

    Education & Advocacy Fellow

    Hello fellow AMSAns! On Tuesday, AMSA was invited to give comments to the Department of Health and Human Services (HHS) on the process and criteria for defining the Essential Health Benefits (EHB) to be covered by plans in the insurance exchanges established by the ACA. I had the privilege to offer remarks on behalf of AMSA based on our Preamble, Purposes and Principles (or PPP). The PPP is the Association’s guiding document as approved by our members through the House of Delegates (HOD). You can download the PPP online and learn more about submitting resolutions to the HOD if you feel that something is missing.

    During the listening session, I was able to speak from the podium and gave these brief remarks. This is the first step of our involvement in the process of defining EHBs – additional opportunities for comment will take place after HHS issues its proposed rules. I look forward to continuing to participate in this and will be sure to keep you informed of the progress!

    If you have any questions or comments, please feel free to contact me!

    Remarks to the Department of Health and Human Services on Essential Health Benefits to be offered under the insurance exchanges:

    My name is Colin McCluney; I am the Education and Advocacy Fellow at the American Medical Student Association. AMSA is the oldest and largest independent association of physicians-in-training in the United States, representing over 36000 members.

    The American Medical Student Association believes that comprehensive health insurance coverage includes but is not limited to primary care, preventive services, reproductive services, acute & chronic care services, dental care, mental health & substance abuse treatment, prescription drugs & medical supplies, ophthalmic care, palliative & end-of-life care, physical & occupational therapy, hearing care and language access services. Services covered as essential health benefits should be determined using an evidence-based methodology. The core of the IOM’s criteria address this well, stating that the benefit must be safe, medically effective, must demonstrate meaningful improvement, and be cost-effective.

    We reject the notion that cost should outweigh coverage in the EHB; skimpy benefits packages simply transfer the costs of care to individuals, continuing the trend of medical bankruptcies and patients avoiding medically necessary care. In addition to further burdening individuals and their families, delayed care will lead to higher costs to the system.

    Value-informed insurance design is a model of plan design which accounts for patient heterogeneity, encouraging the use of cost-effective services and discouraging services in which the benefits do not justify the costs. This model is preferable to the IOM's cost-first model in its attention to individual patient needs, addressing the risk of underuse inherent in a cost-first model. Patients are supported with low co-pays in accessing high-value care and the results are cost-savings and increases in patient compliance.

    We particularly want to emphasize the importance of coverage of mental health, ensuring adequate access as well as coverage which may require standards exceeding parity with physical health. We also encourage the inclusion of patient education by health care providers as essential coverage. Supporting a reimbursement model that values the importance of the patient-physician relationship can improve patient compliance & understanding leading to improvements in individual and population health.

    Finally, we would like to note that while state flexibility may help to drive innovation, strong federal requirements need to be maintained to ensure adequate coverage.

    In summary, the American Medical Student Association supports a comprehensive package of essential health benefits that puts patients first; we support innovation in plan structure, such as value-informed insurance design; and we encourage strong federal requirements for state compliance. Thank you for your time.

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  • Down the Rabbit Hole: The Affordable Care Act Saga Continues in the Courts

    Elizabeth Wiley, JD, MPH

    Vice President for Internal Affairs

    Last Thursday, the Fourth Circuit (Maryland, Carolinas, Virginia, West Virginia) rejected two similar cases challenging the constitutionality of the Affordable Care Act. In Liberty University v. Geithner, the court held that the hypothetical penalties an individual might face under the individual mandate for failing to obtain health insurance constitute a tax. Under the Tax Anti-Injunction Act, such a tax can only be challenge by a taxpayer after paying the allegedly unconstitutional tax. Only then may an individual challenge the constitutionality of a tax and seek a refund. As a result, the constitutionality of the individual mandate may not decided until 2014 at the earliest. In Virginia v. Sebelius, the court similarly held that the state of Virginia did not have standing to challenge the constitutionality of the Affordable Care Act.

    While the Fourth Circuit decisions have been widely heralded as another victory for the administration, the procedural nature of the decisions renders them quite limited in scope. For those of you keeping the Circuit score - it looks like a 1-1-1 right now...

    4th Circuit: Dismissed (procedural).

    6th Circuit: Constitutional.

    11th Circuit: Unconstitutional.

    The American Medical Student Association joined amicus briefs filed by the Center for American Progress, the American Academy of Pediatrics, the National Physicians Alliance, Doctors for America, the National Hispanic Medical Association and the American Nurses Association in both of the Fourth Circuit Affordable Care Act cases.

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