AMA Unfazed by Potential Negative High Court Ruling in Insurance Subsidy Case

By Michael Bologna

June 9 — The newly inaugurated president of the American Medical Association said the association would work closely with both Republicans and Democrats in Congress to remedy any potential gaps that could open in the Affordable Care Act as a result of the U.S. Supreme Court's highly anticipated ruling in King v. Burwell.

In an interview with Bloomberg BNA June 9, Steven J. Stack, an emergency physician practicing in Lexington, Ky., said the AMA would continue to focus on enhancing access to health insurance across the country regardless of the court's determination.

Stack stressed that the AMA's commitment to meaningful health coverage for all Americans extends beyond a single federal statute.

“I don't know what will happen. I do know whatever does happen, we will remain committed to working with the legislative branch to ensure more and more patients have access to health insurance, health insurance they can afford, and health insurance that adequately provides for their needs,” Stack said. “If we don't invest in the health and wellness of the population we are going to pay for it later in their illness and distress.”

Stack was sworn in as the AMA's 170th president during the physician organization's annual meeting in Chicago. In addition to his work as an emergency physician, Stack is a well-regarded authority on health information technology and has served on multiple federal advisory groups to the Office of the National Coordinator for Health Information Technology.

AMA Would Seek Remedies 

Stack said the AMA would seek remedies guaranteeing insurance coverage if the Supreme Court rules in favor of the ACA's opponents and strikes down subsidies provided to Americans who purchased coverage through the federal health-care exchange.

He noted, however, that the court could issue an opinion laced with nuances that could change the broader health reform program. In either circumstance, Stack said the AMA would work with Congress on a solution that ensures affordable, high-quality insurance for Americans.

Stack also stressed the importance of expanded Medicaid coverage under the ACA. He said the AMA would work with the federal Centers for Medicare & Medicaid Services and the states on Medicaid reforms that ensure reasonable access for patients and appropriate rates paid to physicians.

“The evidence is clear that people with Medicaid have better health outcomes than people who are uninsured,” he said. “So, to the extent that Medicaid has helped to make low-income Americans healthier and more productive, then yes we support the Medicaid expansion.”

Lobbying Resources 

Stack said the repeal of Medicare's sustainable growth rate (SGR) formula earlier this year has opened opportunities for the AMA to focus its lobbying resources on matters that have been ignored in recent years and new issues coming to the forefront. On April 16 President Barack Obama signed H.R. 2, which permanently replaces the formula for calculating Medicare physician payments.

“In this post-SGR world we can turn all of our efforts and intentions to all of these other very big things that have been drowned out by SGR every year,” he said.

Stack said AMA would be devoting much of its energy to the Merit-Based Incentive Payment System (MIPS), the new pay-for-performance program created under H.R. 2. MIPS would require payments to professionals to be adjusted based on new performance measures developed over the next few years.

MIPS would consolidate three existing incentive programs—the Physician Quality Reporting System, the value-based modifier program and the Electronic Health Record Meaningful Use program—into a single coordinated program. As envisioned under the law, qualified physicians would receive a composite performance score of 0–100 based on their performance in each of four performance categories: quality, resource utilization, meaningful use and clinical practice improvement activities. Composite scores then would be compared to a performance threshold. Providers falling above the threshold would be eligible for payment increases. Providers failing to meet the threshold would see their payments cut.

Realistic Thresholds 

Stack said the AMA would work closely with the Obama administration and the CMS to ensure the program creates realistic thresholds and incentives for physicians, while minimizing administrative burdens.

“We are going to work very, very hard with the executive branch and HHS to try to create a program that actually does support physicians and their professionalism, and provides good care for patients, and advances those agenda items without having an undue burden on physicians,” he said.

Meaningful Use Adjustments 

Stack said the AMA also would invest time and energy into reforms of the meaningful use program. The association recently provided comments to the agency on the proposed Electronic Health Record Incentive Program—Modifications to Meaningful Use in 2015 Through 2017. He said the AMA called on the CMS to finalize a rule that would pull back the reporting period for the meaningful use program and implement other flexibilities. 

Stack said the AMA endorses the 90-day reporting period for 2015. But he said the “view, download and transmit” (VDT) requirement in Stage 2 of the meaningful use program remains “fraught with problems.”

The proposed rule eases the Stage 2 requirement that 5 percent of a physician's patients view, download or transmit their information through a physician-supported patient portal. But he said VDT becomes “unattainable” during Stage 3.

“We have very serious concerns because they jump it back up to over a 20 percent threshold, which we think and current evidence shows is completely unattainable—particularly when you see the technology isn't working well,” he said.

To contact the reporter on this story: Michael Bologna in Chicago at

To contact the editor responsible for this story: Brian Broderick at