American Medical Student Association

Even after the improvements in coverage due to the Affordable Care Act, over 23 million in the United States will likely remain uninsured, and tens of thousands may die needlessly. A recent survey of U.S. medical students, published in PLoS, published last month, suggests the coming generation of physicians believes in health care for all, and is willing to do their part to achieve this goal. The survey, which included nearly 900 medical students at ten U.S. medical schools, reported that over 86% of medical students agreed or strongly agreed that healthcare should be provided to all regardless of ability to pay. Two thirds (66%) of students indicated they were willing to sacrifice future time and money to provide that care, and nearly three quarters (72%) indicated a preference for a publicly-funded healthcare system.

In a departure from previous studies that have shown a decline in student empathy over the four years of medical school training, these survey also found that this willingness to sacrifice in order provide care increased with increasing student age and years in medical school, and was also correlated with choosing a primary care career focus.

There was no consensus about whether "a publicly-funded national health program would solve the United States health care problems," (approximately 1/3 agree, 1/3 neutral, 1/3 disagree), while only 19% supported private health insurance (19% vs 35% neutral, 46% against).

These results point out an encouraging trend among future students, and the authors suggest a need for increased training in social medicine at medical schools to promote underserved care.

Read the entire survey here.

Whitney McFadden
AMSA National Health Policy Coordinator

Ran Tao
AMSA Associate National Health Policy Coordinator

The pace of progress is slow and incremental undermining of the ACA have begun. The Energy and Commerce Committee passed a piecemeal bill last week (H.R. 1206) to amend an important component of the ACA regulating insurance company profits. 

The new bill adds another layer of complexity to the medical loss ratio (MLR), a measure created by the ACA to monitor the percentage of premiums spent on medical coverage vs. administrative overhead. Currently the ACA mandates insurance companies to have a MLR of 80%, that is 80 cents of every dollar must be spent on medical claims and improving quality of care. However, the infrastructure of insurance companies is a delicate balance, one that rests on making enough profit to pay administrators and insurance brokers alike.

The original ACA policy proclaimed insurance broker and agent commission covered by the 20% allocated for administrative costs. It takes no expert to see that this shift in money balance will greatly restructure insurance company administration and force them to look critically at the business model. In the meantime, the house has decided to take on this burden and change the policies initially created to protect the patient. Insurance broker commission will no longer come from the 20% dedicated to administrative costs. This will shift the burden of cost to the other 80%, taking more money away from actual healthcare and putting it back in the pockets of the company itself.

The question then becomes, how much value does the ACA place on protecting patient premiums for medical care? If the solvency of insurance companies depends on changing this 80/20 balance, then we must either re-evaluate our definition of MLR or the way we are providing health coverage.