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AAMC Principles for the Evaluation of Proposals for the Uninsured
The AAMC has closely monitored the issue of the nation's uninsured,
and advocated for potential solutions, for more than a decade. In
February 2001, the Association's Executive Council endorsed a set
of principles by which the AAMC and its members can evaluate the
potential effectiveness of current and emerging proposals to reduce
the number of Americans without health insurance. The AAMC is committed
to lending its support to advance those proposals which encompass
these guiding principles.
- The AAMC recognizes that the individual health care needs of
the over 42 million Americans living without insurance vary widely
according to their geography, socioeconomic status, race, gender,
and specific medical concerns. While a single initiative that
addresses all of the diverse needs of America's uninsured is unlikely
to be workable or effective, the AAMC believes that priority should
be given to proposals that will have a significant impact on reducing
the total number of uninsured individuals in the United States:
- While Medicaid and other programs are intended to provide health
care coverage for those at or below the poverty level, many state
programs have not achieved this objective. Therefore, the AAMC
supports proposals that—at a minimum—assure coverage to low-income
individuals at, or below, 100 percent of the federal poverty level.
To address the needs of the working poor whose incomes make them
ineligible for Medicaid or other public programs, the AAMC also
favors proposals that provide coverage to low-income individuals
at 200 percent or below the federal poverty level.
- Programs aimed at the uninsured can—and often do—vary in
their implementation according to geography and individual life
circumstances, such as marital, employment, and immigrant status.
The AAMC strongly believes that such circumstances should not
impede an individual's right to medical care in different jurisdictions.
We therefore support proposals that establish national and uniform
eligibility requirements.
- In addition to coverage for acute care in the case of medical
emergencies, health insurance should also provide coverage for
health maintenance and medically proven and recognized preventive
care services that promote the health of individuals and the communities
in which they live. Therefore, the AAMC believes that any proposal
for the uninsured should mandate a minimum benefits package consisting
of appropriate emergency care, inpatient hospital care, preventive
care services (e.g., mammography, Pap smears, flu shots, immunizations,
and prenatal care), care for patients with highly communicable
diseases (e.g., TB), and primary and specialty physician services.
- All too often it is proposed that new health initiatives replace
established programs before their efficacy can be sufficiently
determined. The effectiveness of new programs should be thoroughly
evaluated before old programs are eliminated. Therefore, the AAMC
believes that any new proposals for the uninsured should be financed
in a way that does not prematurely reduce spending on existing
programs, particularly Medicare, Medicaid, and VA programs.
- Many members of America's indigent population are deterred
from taking advantage of insurance programs for which they are
eligible due to co-pays and deductibles that they either cannot
afford or must sacrifice basic necessities in order to pay. The
AAMC supports proposals that assure that beneficiary co-payments
and deductibles are adequately subsidized and set at a rate that
enhances full participation among those eligible to participate.
- In the era of a workforce that frequently changes jobs, the
AAMC recognizes the need for a program for the working poor that
does not penalize them for changing employment by imposing waiting
periods before coverage may be continued. The AAMC also recognizes
the need to protect individuals most vulnerable to being denied
coverage—those with chronic or acute illnesses. Therefore, we
endorse proposals that apply HIPPA provisions of portability,
premium deductibility, and limitations on pre-existing condition
exclusions.
- New proposals for the uninsured can potentially affect the
providers who have served as the nation's traditional safety net
for the medically indigent. The AAMC believes that these implications
should be considered in initiatives that diminish the number of
uninsured so that the vital patient care activities provided by
academic physicians, medical schools and teaching hospitals are
not negatively impacted.
AAMC Executive Council
February 9, 2001
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