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Pandemic-related money woes were a significant concern for attendees at the American Medical Association (AMA) virtual Special Meeting of its House of Delegates.

The New York delegation introduced a policy recommendation calling for the AMA and other stakeholders to lobby for improved and expanded funding for federal stimulus programs, such as the "Coronavirus Aid, Relief, and Economic Security Act" () and the Medicare Advance Payment Program (), which was suspended in April 2020.

Another delegate for the Great Lakes States coalition called for "temporary deferment of loan repayment," including the suspension of interest accumulation throughout that deferment period for medical school educational debt.

Boosting Relief

The CARES Act provided $175 billion in relief funds for hospitals and healthcare providers who provide treatment for patients with potential or actual COVID-19 infections. Initial funding tranches were distributed only to those hospitals and providers who receive Medicare payments, leaving behind certain primary care specialties, including pediatrics, that also provide testing and treatment for patients with suspected COVID-19.

The New York delegation recommendation calls for the following:

• Restart MAPP, significantly lowering the repayment interests rate and extending the repayment period
• Expand the pool of eligible healthcare providers for the CARES Act to include all physicians in need of support, regardless of the kinds of patients they treat
• Amend the Paycheck Protection Program to allow more flexibility for how monies are spent, as well as extending the repayment period
• Request "additional relief to physicians" in the form of loan forgiveness for medical school educational debt

Howard Huang, MD, of New York, who authored the recommendation, explained that he wrote it prior to the Department of Health and Human Services (HHS) announcing additional funding for eligible providers serving Medicaid and Children's Health Insurance Plans (CHIP) patients. Huang thanked the AMA for helping to secure that funding.

Joseph Sellers, MD, a delegate from New York and a pediatrician, said he strongly supported the original policy recommendation, and that the timing is important given that a federal stimulus package is forthcoming. The AMA requests should be a part of that package, he said.

"It's really unconscionable that we've had physicians and other healthcare entities being loaned money at 10.5% interest when banks can get it much cheaper than that. So...are banks more important than physicians?" he said.

The for the resolution, "CARES Act Equity and Loan Forgiveness in the Medicare Accelerated Payment Program," outlines the recommendation. A final decision on will be made by the full AMA House of Delegates.

Deferment Vs Forgiveness

Jayne Courts, MD, a delegate for the Great Lakes States coalition, put forward an amendment to the New York recommendation calling for the temporary loan repayment deferment.

"While we certainly agree that medical school educational debt should not be a significant financial hardship, we do not think that the COVID pandemic is a reason to seek loan forgiveness," Courts said. "We also think that deferment of loan repayment is far more likely to be supported by Congress than loan forgiveness."

Huang reported that some hospitals have been advocating for loans to be converted to grants, and suggested physicians could benefit from a similar approach.

Jim Milam, MD, a delegate from Illinois, who speaking on his own behalf, called for referring the policy provision related to loan forgiveness to the AMA board, arguing that while he sympathized with his struggling colleagues, lawmakers are not inclined to support physicians financially.

"It's an unfortunate political reality that they look at doctors as rich," he said. "We are not Chrysler and we are not Wall Street...and they do not perceive us as needing grants."

Kevin Bernstein, MD, an American Academy of Family Physicians delegate, shared that he has $280,000 in student loan debt. He supported the recommendation and the concept of loan forgiveness for student debt, as any "additional relief" is appreciated.

'All the Help They Can Get'

Barbara Hummel, MD, a delegate from Wisconsin and an independent family physician, said she opposed the Great Lakes amendment and supported the idea of grants.

She stressed that independent physicans, particularly those in primary care, need "all the help they can get."

"My practice is basically bankrupt," she said. "I'm providing funds to keep it open from my retirement funds and unless we get more help from the government, we're not gonna survive. And at a time when we need more primary care doctors rather than less...with the ever increasing number of...COVID patients, this is unacceptable."

Heather Smith, MD, MPH, a member of the AMA Council on Legislation, noted that the AMA doesn't have specific policy on the issues outlined in the recommendation, but the AMA has been "vigorously advocating" for student loan forgiveness, and funding provisions that were included in the CARES Act. The recommendation aligns with these ongoing efforts and for that reason the council will support its adoption, she said.

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