Psychiatr News July 7, 2006
Volume 41, Number 13, page 5
© 2006 American Psychiatric Association
AMA Wants Govt. to Enact Law on Insurance Coverage
Mark Moran
The AMA House of Delegates tackled many issues of importance to psychiatry
last month. Among them are mandated health insurance, direct-to-consumer
advertising, and use of SSRIs during pregnancy.
The AMA, in a significant reversal of longstanding policy, approved a call
for mandated health insurance.
Under the AMA plan, individuals and families earning more than 500 percent
of the federal poverty level ($49,000 for an individual and $100,000 for a
family of four) would be required to obtain minimum insurance coverage of
catastrophic health care and evidence-based preventive health care,
"using the tax structure to achieve compliance."
In a press conference following the action by the AMA's House of Delegates
last month, AMA Trustee Ardis Hoven, M.D., told reporters that use of the tax
structure meant those who neglected to buy health coverage would be subject to
higher taxes.
For those earning less than 500 percent of the federal poverty level, the
AMA would support a similar requirement upon implementation of a system of
refundable tax credits or other subsidies to obtain health care coverage.
Though an entirely theoretical approach that has little likelihood of
becoming reality anytime soon, the move marks a significant turnabout for a
group that has consistently resisted mandatory health insurance in favor of
voluntary incentives.
Hoven and fellow board member Edward Langston, R.Ph., M.D., emphasized the
value of patient "accountability," the need for individuals to
bear responsibility for their own coverage.
When asked if the new policy was a move toward government-provided health
insurance, or a "single-payer" plan, Hoven replied, "This
enables and encourages individuals to have their own individually owned health
plan. That's not a single-payer plan."
Still, the resolution on mandatory insurance was among the most important
policy measures undertaken by the House of Delegates.
"This policy is the newest addition to the AMA's plan to cover the
uninsured," Hoven said. "The AMA plan now includes tax credits for
the purchase of insurance, individually selected and owned health insurance,
the expansion and formation of new insurance options, changes in health
insurance market regulations, and individual responsibility."
More Consumer Ad Monitoring Urged
In another area relevant to all of medicine, the house approved a report
calling for a temporary moratorium on direct-to-consumer advertising (DTCA) of
newly approved drugs and the development of guidelines for pharmaceutical
companies to follow when preparing such advertising. The time interval for
this moratorium will be determined by the Food and Drug Administration (FDA),
according to a report prepared by the AMA Board of Trustees.
The new AMA guidelines for DTCA state that those ads should do the
following:
- Provide objective information about drug benefits that reflect the true
efficacy of the drug, as determined by clinical trials.
- Show balance between the benefits and risks of the advertised drugs by
providing comparable time or space and cognitive accessibility, and by
presenting warnings, precautions, and potential adverse reactions in a clear
and understandable way without distraction of content.
- Indicate clearly that the ad is for a prescription drug and refer patients
to their physician for more information and appropriate treatment.
- Be targeted for age-appropriate audiences.
- Have pre-approval from the FDA.
"The AMA report clearly supports the need for closer monitoring of
direct-to-consumer advertising of pharmaceutical products," said David
Fassler, M.D., the delegate to the AMA house from the American Academy of
Child and Adolescent Psychiatry and author of a resolution originally calling
for the report (Psychiatric News, July 15, 2005).
"In particular, I agree with the call for a moratorium on such
advertising for a period of time after a new medication is initially
approved," Fassler said. "Large-scale use by a wide range of
patients is very different from carefully controlled clinical trials.
Physicians need time to gain firsthand experience with new medications. In the
long run, I believe the AMA's actions will improve safety without limiting
access to necessary and appropriate treatment."
Other Psychiatric Issues
In other business relevant to psychiatry, the house approved a resolution
seeking a report by the AMA's Council on Science and Public Health (CSPH) to
clarify uncertainties surrounding the use of selective serotonin reuptake
inhibitors (SSRIs) during pregnancy.
Testifying in favor of the resolution, APA vice President Nada Stotland,
M.D., put a "human face" on the clinical controversy.
"My subspecialty is the psychiatric aspects of women's reproductive
health," she said. "I see women patients who are pregnant and
clinically depressed. I can tell them that untreated depression poses a danger
to them and to their pregnancies. I can tell those whose depression has been
successfully controlled with medication that there is a 60 percent chance that
their depressions will recur if they discontinue that medication. They tell me
that they are reading in the popular press that antidepressants can hurt their
growing fetuses. The prospect of doing anything that might harm their babies
is agonizing.
"I also receive many calls from colleagues caring for pregnant women,
raising these same concerns," she continued. "Patients look to
their physicians for expert advice, and their physicians look to our AMA for
the evidence-based guidelines on which they can base that advice. This
resolution will put AMA guidelines into the hands of our colleagues so that
they can offer their patients and their families the best possible information
on which to make these difficult decisions."
The house also approved a report by the CSPH advocating for increased
availability of mental health services for college students. The report calls
on AMA to do the following:
- Evaluate insurance coverage of this high-risk population and recommend
approaches to ensure mandated, full health insurance coverage for full-time
undergraduate and graduate students.
- Advocate for elimination of college and university policies that
discriminate against students who disclose or seek treatment for depression,
substance use disorders, or other mental health problems.
- Encourage clinical staff of campus health services and campus counseling
services of colleges and universities to improve their skills in screening,
conducting brief interventions, and making student referrals for problem
drinking.
- Continue to work to repeal state laws and insurance codes that allow denial
of insurance payments to treat injuries as a result of an insured person's
being intoxicated.
Three other items sponsored by APA and affiliated organizations were also
approved by the house:
- A resolution requesting the CSPH to prepare an update to its 1997 report on
the diagnosis and treatment of attention-deficit/hyperactivity disorder. It
was sponsored by APA, AACAP, the American Academy of Psychiatry and the Law,
and the American Academy of Pediatrics.
- A resolution urging the Centers for Medicare and Medicaid Services to
institute and enforce regulations, policies, and guidance for Part D
prescription drug plans that will ensure continuity of care for Medicare
beneficiaries, eliminate access barriers for psychotherapeutic drugs, and
fairly compensate physicians for additional administrative burdens imposed by
the Medicare Part D prescription drug program.
- A resolution calling on the AMA to encourage state and county medical
societies to advocate for initiatives ensuring all eligible children,
adolescents, and young adults are enrolled in Medicaid and the State
Children's Health Insurance Program (SCHIP); and that the AMA advocate for
federal and state funding for Medicaid and SCHIP so that funding is sufficient
to support enrollment and provision of necessary services to all eligible
children, adolescents, and young adults. The resolution also asks the AMA to
encourage state and county medical societies to oppose state efforts to
increase Medicaid beneficiaries' premiums and other cost-sharing measures.
More information about the 2006 annual meeting of the AMA House of
Delegates is posted at
<www.ama-assn.org/ama/pub/category/15931.html>.
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