AMA adopts policy advocating for Medicaid expansion

Key takeaways:

• The AMA House of Delegates adopted new policies advocating for Medicare and Medicaid expansion.
• Current patchy coverage and benefits can leave patients with major expenses or untreated health concerns.

The AMA adopted new policies on broader Medicare and Medicaid health care coverage during its annual House of Delegates meeting.

“Advocating for a healthier nation means advocating for expanded Medicaid,” Pratistha Koirala, MD, PhD, a member of the AMA Board of Trustees, said in a press release.

Vision, hearing and dental coverage

Even though Medicaid offers basic dental, vision and hearing care to pediatric enrollees, these are optional benefits for adults, and coverage can “vary drastically” across state lines, according to the release. For example:

• 33 states offer some Medicaid vision coverage, but 28 limit access based on other factors like pre-existing conditions or severity of the impairment;
• 28 states provide some Medicaid hearing coverage; and
• 19 states provide comprehensive dental coverage, whereas 31 offer only emergency or limited coverage.

Currently, “Medicaid’s patchwork coverage” can leave patients with untreated concerns, so the AMA will work with state medical associations interested to bolster efforts to cover hearing aids, hearing and vision exams, aural rehabilitation services, cochlear implants and visual aids like glasses and contacts. The new policy additionally advocates for working with national organizations like the American Dental Association to improve access to dental care.

“There isn’t much logic to the fact that most Medicaid patients don’t get comprehensive coverage above the neck,” Koirala said in the release. “Failure to address vision, hearing and dental issues not only leads to more severe health problems but also represents preventable obstacles to work and everyday life.”

Medigap policies

The AMA additionally adopted a resolution that called for federal policy change to reduce the burden and cost to patients seeking to switch from Medicare Advantage to traditional Medicare.

Currently, patients who want to switch may not be able to enroll in a Medigap plan for out-of-pocket costs. Medigap provides a one-time 6-month enrollment period, at which time patients are protected by community rating and “guaranteed issue,” which prevent discrimination based on gender, age or health. The guaranteed issue protections also prevent insurers from denying eligible applicants a Medigap policy.

The new AMA policy supports Medigap’s plans that offer guaranteed lifetime enrollment eligibility, modified community rating regulations and annual open enrollment periods. The AMA also supports efforts to expand Medigap policy access to all patients who qualify for Medicare benefits.

“This guarantee is baked into the Affordable Care Act marketplaces but is not yet part of Medicare,” Scott Ferguson, MD, a member of the AMA Board of Trustees, said. “There are good reasons that patients switch to traditional Medicare, and they shouldn’t have to pay a higher cost to do so.”