July 27, 2017

Issue Spotlight

The skinny on partial repeal: It would unravel individual market

There was a flurry of activity in the Senate featuring the dramatic return of Sen. John McCain, R-Arizona, days after being diagnosed with glioblastoma, a tie-breaking vote cast by Vice President Mike Pence, and much speculation over what will happen next.

A likely scenario includes the introduction of a "skinny repeal" that would eliminate some the mandates and taxes included in the Affordable Care Act (ACA). Last year, the Congressional Budget Office (CBO) projected repealing the individual insurance mandate would result in some 15 million more people being uninsured by 2026. This includes some 2 million who would lose employment-based coverage, 6 million fewer buying insurance from the insurance exchange marketplace, and 7 million fewer covered by Medicaid.

The AMA has asked senators to consider the impact proposed legislation would have on the health of all Americans. The Association has maintained that Senate efforts must not increase the number of Americans without health insurance, further weaken the individual insurance market, undermine critical safety net programs, or make it harder for low- and moderate-income Americans to obtain quality, affordable health insurance.

"To date, the amendments proposed to repeal or replace the Affordable Care Act fail to meet these basic requirements and would harm vulnerable patients in every state," said AMA President David O. Barbe, MD, MHA, adding that a potential partial repeal would be no different.

"There has been considerable speculation regarding a so-called 'skinny package' that would primarily eliminate penalties related to the individual and employer mandates and provide tax cuts to device manufactures and the health insurance industry," Dr. Barbe explained. "Eliminating the mandate to obtain coverage only exacerbates the affordability problem that critics say they want to address. Instead, it leads to adverse selection that would increase premiums and destabilize the individual market."

Read more at AMA Wire®.

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National Update

Administration urged to provide additional clarity on travel ban

In a letter to Secretary John F. Kelly of the Department of Homeland Security, the AMA expressed strong concerns regarding the implementation of the executive order "Protecting the Nation from Foreign Terrorist Entry into the United States." The executive order was reinstated after the Supreme Court ruled on June 26, 2017. 

The AMA agrees with the administration's subsequent guidance that explicitly allows: students (including medical students); those with offers of employment (such as residents, fellows and other physicians); and lecturers to be admitted to the U.S. Yet the AMA fears the guidance is not as broad as it needs to be and it is still creating confusion for international medical graduates, scientific researchers, those attending medical conferences and the medical community. The AMA also expressed concern that the additional case-by-case waiver policy on patients from the six identified countries will have a chilling effect on individuals seeking critical medical care. The AMA urges the administration to provide clarity to address these issues.

Read more at AMA Wire.

Legislation proposes funding CDC for gun-violence prevention research

On July 24, the AMA sent letters to Sen. Edward Markey, D-Mass., and Rep. Carolyn Maloney, D-N.Y., in support of their bills, S. 834/H.R. 1832. The legislation would provide funding for research by the Centers for Disease Control and Prevention (CDC) on firearm safety and gun-violence prevention.

For more than 20 years, the CDC has lacked support from Congress to conduct firearm violence research. The paucity of gun-violence research has contributed to the lack of meaningful progress in reducing firearm-related injuries. Significant research investments could address these issues by helping provide a more accurate understanding of the problems associated with gun violence and to determine how best to reduce the high rate of firearm-related deaths and injuries. AMA policy supports providing sufficient resources to enable the CDC to conduct an epidemiological analysis of the data on firearm-related injuries and deaths.

Earlier this year, the AMA—along with the American Bar Association and nine other local, state, and specialty medical societies—convened a program on developing a public health response to reducing gun violence, including priorities for a research agenda and physicians' role in preventing gun violence.

Videos of the presentations are now available:

Read more at AMA Wire.

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State Update

Anthem emergency care policy harmful to patients

As of July 1, 2017, Blue Cross Blue Shield of Georgia (BCBSGA), and its parent company, Anthem, says it may not pay for care received in an emergency department if it is later determined that the patient was not in need of emergency medical care. Letters sent to thousands of Georgians who purchased BCBSGA plans in the individual market state that an emergency will ultimately be determined by the insurer, potentially leaving patients and physicians holding the bag for the cost of care and deterring patients from seeking emergency care in the first place. 

And Georgia is not the only state affected. This policy is now live for some Anthem patients in Missouri and anticipated in several other states soon. The Medical Association of Georgia and the American College of Emergency Physicians have been actively and loudly opposing this harmful policy, and the AMA sent a letter to the CEO of Anthem last month stating serious concern with the policy. The AMA letter outlined the financial and clinical impact on patients, suggested that that the policy may be in conflict with federal and state laws. The AMA asked that Anthem rescind the policy immediately.

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Other News

Preparing for the Social Security Number Removal Initiative (SSNRI)

As described in prior editions of AMA Advocacy Update, CMS will begin mailing new Medicare cards with a new number—the Medicare Beneficiary Identifier, or MBI—to beneficiaries in April 2018, replacing the Social Security Number identifier now used on the cards. Physicians should talk to their practice managers and health IT vendors now, however, to ensure their systems will be ready to accept the MBI.  These software changes can take many months. 

Physicians should pass along this technical information from CMS to their practice managers and health IT vendors.

Identify your patients who qualify for Medicare under the Railroad Retirement Board (RRB). You will no longer be able to distinguish RRB patients by the number on the new Medicare card. You will be able to identify them by the RRB logo on their card, and we will return a message on the eligibility transaction response for a RRB patient. The message will say, "Railroad Retirement Medicare Beneficiary" in 271 Loop 2110C, Segment MSG. If you use the number only to identify your RRB patients beginning in April 2018, you must identify them differently to send Medicare claims to the RRB Specialty Medicare Administrative Contractor, Palmetto GBA.

Update your practice management system's patient numbers to automatically accept the new Medicare number or MBI from the remittance advice (835) transaction. Beginning in October 2018, through the transition period, CMS will return your patient's MBI on every electronic remittance advice for claims you submit with a valid and active HICN. It will be in the same place you now get the "changed HICN": 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code).

More information about the SSNRI is available at CMS' New Medicare Card webpage, including the MBI format specifications.

New CME training about the HIPAA Right of Access available

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has launched a new video training module for health professionals on patients' right of access under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

The video module provides an in-depth review of the components of the HIPAA right of access and ways in which it enables individuals to be more involved in their own care.  The module also provides helpful suggestions about how health care providers can integrate aspects of the HIPAA access right into medical practice.

Upon completion of this activity, participants will receive free Continuing Medical Education (CME) credit for physicians and Continuing Education credit for health professionals. 

The module is available via Medscape or at the OCR's Training and Resources webpage.

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Upcoming Events

Oct. 27–29:
Become an advocacy expert by attending the Candidate Campaign School at the AMA office in Washington, D.C. The school is targeted to AMA members, their spouses, residents, medical students and medical society staff who want to become more involved in the campaign process. Faculty, materials and meals are covered by AMPAC. Participants are responsible for the registration fee ($350 for AMA members, $1,000 for nonmembers), airfare and hotel accommodations. Learn more or apply; contact us at

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