Clinical Care Legislative and Policy Priorities

AAMC-member teaching hospitals, health systems, and faculty physicians cultivate and provide high-quality health care, especially for the most complex and vulnerable patients, many of whom are unable to receive care elsewhere. While only 5% of all inpatient, short-term, nonfederal U.S. hospitals are AAMC-member teaching hospitals, these teaching hospitals and health systems and their faculty physicians provide a disproportionate amount of care for their communities. AAMC-member teaching hospitals and health systems also provide specialized services to their communities that often are unavailable elsewhere, offering benefits that reach far beyond charity care to improve the lives of patients everywhere.

Clinical Care Priorities

Medicare Support for Physician Training
Health Care Coverage and Access
The 340B Drug Pricing Program
Rural and Underserved Communities’ Access to Health Care
Maternal Health

Medicare Support for Physician Training

While teaching hospitals and health systems provide the lion’s share of funding for graduate medical education (GME) and physician training, Medicare is the primary public source of support. Medicare funding helps to offset the stipends paid to residents, the costs of supervision, and the increased costs associated with operating teaching programs. As part of the Balanced Budget Act of 1997, a hospital-level cap was placed on Medicare support for GME which has stymied significant increases in residency training, creating a bottleneck for the physician workforce.

Broad bipartisan coalitions of members of Congress representing diverse districts, states, and communities worked together both at the end of 2020 to provide 1,000 new Medicare-supported GME positions, and at the end of 2022 to provide an additional 200 positions – the first increases of their kind in nearly 25 years. These increases in residency positions were an important initial investment, but more positions are needed to help ensure a diverse physician workforce and that patients throughout the country can access the primary and specialty care they need.

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Health Care Coverage and Access

The AAMC is committed to ensuring that all people, regardless of socioeconomic status, have access to high-quality, affordable health care coverage. We support policies to strengthen the Affordable Care Act and reduce the number of uninsured people throughout the country, such as by expanding subsidies in the ACA marketplaces. We strongly support both increasing and maintaining access to Medicaid, which is a key source of coverage for the nation’s low-income and vulnerable patients, many of whom have complex health care needs. For the health of all, it is essential that policymakers and other stakeholders continue to develop ways to increase access to coverage and address longstanding inequities. Without sufficient coverage, individuals often forgo routine care, which leads to more costly and complex care later.

The AAMC supports federal policies to guarantee that coverage confers access to care. AAMC-member institutions provide highly specialized health care services that are often unavailable in other settings, including a wide range of primary, specialty, and sub-specialty care. AAMC members care for a disproportionate share of Medicare, Medicaid, dual eligible, and uninsured patients, despite unsustainably low reimbursement provided by public payers. To ensure that these patients can continue to access essential health care services, the AAMC supports policies to remove barriers to care and promote the long-term financial sustainability of academic medicine.

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The 340B Drug Pricing Program

A pharmacy technician grabs a bottle of drugs off a shelf at the central pharmacy of Intermountain Heathcare on September 10, 2018 in Midvale, Utah.

The AAMC is committed to advancing policies that help our members cultivate and enhance community partnerships and care for the underserved. For over thirty years, the 340B Drug Pricing Program has allowed safety-net hospitals, many of which are teaching hospitals, to provide low-income, historically under-resourced patients and communities with access to lifesaving health care services. AAMC-member institutions leverage their 340B savings to invest in a wide array of programs and services, including prescription drug assistance and medication management, mobile health clinics, immunization programs, nutrition supports, and affordable housing. These critical investments are made possible by the 340B program at no cost to the taxpayer.

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Rural and Underserved Communities’ Access to Health Care

The AAMC is committed to increasing access to physicians, especially in rural and underserved communities. To that end, AAMC supports expanding medical schools and branch campuses in rural and underserved areas, including increasing enrollment of students from those communities; increasing related training through Rural Residency Planning and Development grants; supporting Rural Track Programs (RTP) partnerships between rural hospitals and teaching hospitals and health systems; recruiting and training future physicians in rural areas through HRSA Title VII Area Health Education Centers (AHECs), as well as other workforce recruitment programs such as the National Health Service Corps, Public Service Loan Forgiveness, and Conrad State 30 J-1 Visa Waiver Program.

Teaching hospitals and health systems and their faculty physicians have invested in the infrastructure necessary to provide telehealth services to enhance medical care for their patients, especially during the COVID-19 public health emergency (PHE). Telehealth provides both patients and providers with a variety of benefits and expands access to care, particularly for those in rural and other underserved areas. The AAMC supports the telehealth waivers and regulatory changes that Congress and CMS have implemented in response to the PHE.

As the PHE has ended, we continue to support additional efforts by Congress to ensure that Medicare beneficiaries and other patients can maintain this access to telehealth services beyond the pandemic, including permanently removing patient location and rural site requirements to allow patients to access telehealth visits in any location (including in their home) and permanently allowing Medicare payment for audio-only services. Additionally, the AAMC urges Congress to continue reimbursing providers the same amount for telehealth services as in-person visits. Without sufficient reimbursement, providers may no longer be able to continue to provide the current level of telehealth services to their patients.

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Maternal Health

The maternal death rate in the United States is significantly higher than other, similar, countries – and it is estimated that over 60% of pregnancy related deaths are preventable. Outcomes are even worse for Black women, who are three to four times more likely to die from pregnancy-related causes than non-Hispanic white women, and who experience the impact of these disparities regardless of education and income.

The AAMC is committed to advancing federal policies that include a multipronged approach that avoids preventable deaths, provides patients with optimal clinical care, improves maternal health, ensures health care coverage for perinatal people, and promotes health equity, including partnership with communities and stakeholders.