AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 122
(A-04)
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Introduced by:
District of Columbia Delegation
Subject:
Division of Medicare into a Program for Elderly (Part A) and a Program for the
Disabled (Part D)
Referred to:
Reference Committee A
(Joan E. Cummings, MD, Chair)
Whereas, The Medicare budget is massive and poorly understood; and
Whereas, Medicare is misunderstood as a “seniors program,” which subsequently has
enormous political and budgetary implications; and
Whereas, A significant portion of Medicare expenses goes to non-seniors, especially the
disabled; and
Whereas, The Medicare program for the disabled is critical and vital; and
Whereas, The Medicare programs for the disabled have nothing in common with that of seniors;
therefore be it
RESOLVED, That our American Medical Association refer to the appropriate Council the issue
of dividing Medicare into two programs--Medicare A for seniors and Medicare D for the disabled,
which will allow a more appropriate analysis of budgetary, policy, and strategic planning of the
two programs (Directive to Take Action); and be it further
RESOLVED, That our AMA report its results back to the House of Delegates at the 2004 Interim
Meeting.
Fiscal Note: Undertake study and develop report at estimated staff cost of $6,060.
Received: 5/4/04
Resolution: 122 (A-04)
Page 2
RELEVANT AMA POLICY
H-165.890 Medicare Transformation.
Current Status: (1) The AMA reaffirms that the fundamental goal of transforming Medicare
should be to assure the health of the elderly and disabled populations. Patients must have
access to high quality medical services. The best value in medical care can be achieved by
ensuring that the medical profession has a central role in the design and implementation of a
new Medicare program. Patients must also receive timely and accurate information on the
necessity and important aspects of Medicare transformation. (2) That in the context of changes
that enhance the fiscal solvency of Medicare, increase beneficiary choice, and encourage
program privatization, AMA should accept a defined contribution by the federal government
toward the purchase of private health care coverage by Medicare beneficiaries. This defined
contribution should equal the national average risk adjusted actuarial value of the government
Medicare contribution for individuals retaining traditional Medicare coverage. adjusted
geographically to reflect only demonstrable differences in practice costs and correctly validated
variations in utilization, with further adjustments as needed to expeditiously remedy
demonstrable access problems in specific geographic areas. In particular, areas that have
relatively low utilization rates due to cost containment efforts should not be penalized with
unrealistically low reimbursement rates. In addition, these payments should be adjusted at the
individual level with improved risk adjustors that include demographic factors, health status, and
other useful and cost-effective predictors of health care use. The value of this contribution
should reflect the cost of access to needed health care, including preventive services, and the
need to establish the fiscal solvency of Medicare. (3) AMA policy should include approach that
restructure Medicare beneficiary deductibles, coinsurance, premiums, and Medigap insurance
to enhance the effectiveness of cost sharing, increase patient choice, maintain beneficiary
financial protection, and reduce costs to Medicare and beneficiaries from Medigap coverage.
This restructured cost sharing should include appropriate incentives for patients to seek and
receive preventive services. (BOT Rep. 44, A-95; CMS Rep. 7, I-95; Reaffirmed: BOT Rep. 19
and Res. 131, A-99)