'We Need It Now': AMA Delegates Urge Public Health System Funding, Support

— COVID-era funding is drying up as Medicaid rolls are shrinking

by Joyce Frieden, Washington Editor, �鶹��ý June 15, 2023

CHICAGO -- The public health infrastructure in this country needs more support and funding from the federal government, American Medical Association (AMA) House of Delegates members declared.

"The funding we received during COVID is drying up," Ajanta Patel, MD, medical director at the Chicago Department of Public Health, said at Tuesday's House of Delegates meeting. "What has not been spent is going to be redistributed and go back to the federal government. We need funding, and we need it now."

Patel, a delegate for the American Thoracic Society, was speaking for herself in response to a resolution from Joe Ortega, MD, MPH, of San Antonio. Ortega, a delegate from the Aerospace Medical Association, presented a resolution asking the AMA to "continue to support increased funding for public health infrastructure and workforce, which should include funding for preventive medicine-related residency programs, to increase public health leadership in this country."

Douglas Martin, MD, of Sioux City, Iowa, spoke in support of the resolution. "I have spent the last 3 years ... fighting for residency funding in occupational environmental medicine as well as general preventive medicine residencies," said Martin, alternate delegate from Iowa and immediate past president of the American College of Occupational and Environmental Medicine.

Because of the way such residency funding is allocated, "we have to go back to Washington, D.C., every year and fight," said Martin, who spoke with the support of the delegates' North Central delegation. "You would think after a pandemic that the eyes would have been opened and increased funding would have been [easy to get]. But unfortunately, it is not. So if we could get your help with this, we would greatly appreciate it."

"This is an urgent issue," agreed Seth Flagg, MD, of Silver Spring, Maryland, an alternate delegate for the American Society of Addiction Medicine who was speaking for himself. "Underpinning every one of our policy issues is funding to implement it in the real world ... That has to be part of making this real, versus [just] AMA policy."

The resolution passed with a voice vote.

Delegates also discussed a report by the AMA Board of Trustees on the association's public health strategy. The report recommended that the AMA continue to "improve collaboration between medicine and public health" and "promote evidence-based clinical and community preventive services."

However, the lack of specific timelines for action did not sit well with the American Academy of Pediatrics (AAP) delegation, whose members wanted action on issues relating to the mental health crisis and Medicaid, among other topics.

"I can't wait another year to hear about our mental health crisis and the things that we're doing to protect our patients and our own physicians against this epidemic," said Melissa Garretson, MD, of Fort Worth, Texas, speaking as an AAP delegate. "When you look at the Medicaid protections that are undone by the end of the pandemic, while I'm glad it's no longer a pandemic, currently 750,000 people have already fallen off the rolls of Medicaid, most of them children and most of them secondary to technical difficulties with re-signing up for Medicaid ... And as a person who takes a lot of Medicaid patients, it's critically important for me to help us advocate on this issue."

The AAP delegation pushed to add resolutions requiring the AMA to update members at the organization's interim meeting in November 2023 on its initiatives regarding the ongoing mental health crisis in the U.S. They asked for similar updates on loss of Medicaid coverage following the "unwinding" of the COVID-19 public health emergency and its protections for Medicaid patients, as well as "a strategic plan or outline" on the health effects of climate change and an update from the AMA's task force on gun violence.

Lisa Costello, MD, of Morgantown, West Virginia, an alternate delegate for West Virginia who was speaking for the delegation, said she would especially welcome the Medicaid report.

"As a pediatric hospitalist in a rural state one who also practices public health, I can tell you that the majority of the patients that I see in the hospital are covered by Medicaid, and we need to have reports on the impact that the Medicaid re-determination are having on our patients," she said. "In my state of West Virginia, 42,000 individuals -- mostly children -- have come off the rolls of Medicaid, 87% of them for procedural reasons."

Overall, her delegation wanted more than just a narrow report, she added. Having the board report on the additional items "is something that can help us understand and act as leaders to address these public health issues facing our states and communities."

The delegates voted vocally in favor of adding the AAP resolutions to the report.

Joyce Frieden oversees �鶹��ý’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy.