Voting Access a Hot Topic Among AMA Delegates

CHICAGO — What’s the best way to support safe access to voting? American Medical Association (AMA) House of Delegates members were sharply divided on this issue Monday at their special meeting.

House members were discussing a resolution from the Resident and Fellow Section and the Medical Student Section on the issue of access to voting; the reference committee that heard testimony on the resolution proposed making it AMA policy that the association support measures such as extended polling hours, increased polling locations, extended early voting periods, and mail-in ballots for which postage is free “as a harm-reduction strategy to safeguard public health and mitigate unnecessary risk of infectious disease transmission.” The committee also recommended that the AMA oppose constraints on mail-in voting.

Jordan Warchol, MD, who was speaking for the Nebraska delegation, proposed getting rid of that language and replacing it with one sentence saying that the AMA will “advocate for safe and equitable access to voting that’s mindful of public health.”

“Nebraska is definitely in favor of making sure that patients have the ability to vote; that’s not what this amendment is about,” said Warchol. “I do think that we also need to be in favor of broad policy that allows our members and staff to adapt to changing situations as they arise. And I think that the current language that I’ve [removed] is a little bit prescriptive in that manner. This also changes the action word from ‘support’ to ‘advocate’ which allows our AMA to work towards a viable solution for our patients, as opposed to supporting things that may be outside of our control when they arise in state or federal legislatures.”

Lots of Opposition

The proposal was met with vocal opposition. The amendment “really changes completely what the authors of the resolution — with the support of the reference committee — are proposing,” said Ken Certa, MD, a delegate for the American Psychiatric Association who spoke for himself. “Social determinants of health are clearly something that should be very much on the minds of everyone in this room; it certainly is in our association. The disenfranchisement of people by their not being able to get to the polls is a real problem. Having this kind of policy in our AMA compendium would be very important to ensure that every voice is heard, and I really strongly support the original.”

Not everyone was opposed, however. “I thank Nebraska for bringing some sanity to this resolution,” said Greg Cooper, MD, a delegate from Kentucky who spoke for himself. He noted that during a reference committee hearing on the topic, “the most cogent comment that was made was to point out that the process of voting in the United States is decentralized, with voting procedures largely determined by the states. So being prescriptive in raising all these issues that were included in this resolution have very little meaning when you go state to state.”

Halea Meese, MD, an alternate delegate from New Mexico who was speaking for the Resident and Fellow Section, disagreed. “We have not done a good job as the house of medicine in protecting the most vulnerable among our population from the dangers they are experiencing by overcrowded, in-person voting conditions,” she said. “This is not something that is overly prescriptive. It simply is providing possible roadmaps and ideas for how to proceed. I don’t think it ties the hands of our policy and advocacy team in any way.”

As for the issue of voting regulations being decentralized, “we’ve seen under multiple circumstances the need to further centralize voting in the form of the Voting Rights Act and other federal legislation,” Meese added. “So I would respectfully disagree with the notion that we can just leave this up to the states.”

The Nebraska amendment was defeated by a vote of 189 for to 259 against. Warchol then moved to refer the resolution to the AMA’s Board of Trustees for further discussion, but that motion was also defeated.

Should Physicians Be Held Responsible?

The delegates also discussed a report from the AMA Council on Science and Public Health regarding physician involvement in state regulations on driving and/or firearm use by people with cognitive function deficits due to a traumatic brain injury. The report — as amended by a House of Delegates reference committee — encouraged the NIH and other funders to “expand research on cognitive impairment, including traumatic brain injury (TBI), as a risk factor for harm to self or others that may impact driving and/or firearm ownership, and the role of the physician in decreasing risk of morbidity and mortality.”

Maya Babu, MD, speaking for the neurosurgery delegation, asked that that particular recommendation be changed to encourage the researchers to investigate “the role of the physician in counseling patients so as to reduce the risk of morbidity and mortality.” “We all recognize the tremendous value we as physicians have in counseling our patients,” she said. “However, we do not believe it is reasonable to hold physicians responsible for the behavior of our patients. Increasingly we see movements by the government and insurers towards assigning more and more unrealistic culpability for aspects out of our control.”

Heidi Hullinger, MD, who was speaking for the American Academy of Orthopedic Surgeons, supported the amendment. “We do think that this further clarifies the role of physicians,” she said. “We don’t have an ability to definitively decrease the risk, and that could potentially have medicolegal implications. Instead, we have a role in counseling and doing what we can to minimize the risk.”

Padmini Ranasinghe, MD, who spoke on behalf of the Council on Science and Public Health, disagreed. “We appreciate our neurosurgery colleagues bringing this forward; however, we think the reference committee got it correct,” she said. “The physician’s role is a little bit broader than counseling in this area. So keeping it the reference committee language would give us more options as physicians.” The delegates voted 384-87 to approve the change.

Emergency Resolution Effort Defeated

The meeting got off to an eventful start when Jay Gregory, MD, speaking for the Oklahoma delegation, sought to introduce an emergency resolution asking the AMA to “urgently prepare a strategic plan to address the current healthcare workforce shortage crisis that disproportionately affects rural areas and underserved urban areas” — a crisis that the resolution suggested would likely get worse after the Biden administration’s COVID-19 mandate for healthcare workers — which was announced on November 4 — takes effect in January.

“I want to state emphatically that this is not an ‘anti-vax’ or ‘anti-mandatory’ resolution,” he said. “Oklahoma was a leader in vaccination, and we support vaccination and mandatory vaccinations. “This is an emergency access to care issue, to ensure we have the capacity to provide essential services moving forward … We fear that if we don’t speak out today, we may witness a severe crisis in access to care, which will disproportionately impact the most vulnerable patients in underserved and rural areas.”

Delegates’ reactions to this effort were mostly negative. “My husband is a hospital president in our rural town in Texas,” said Melissa Garretson, MD, who spoke on behalf of the American Academy of Pediatrics. “This is not a new issue. This is not a emergent issue. This isn’t something that we just figured out on Wednesday night; it’s been going on for months and months and months, so I don’t feel like it meets any of the criteria for an emergency resolution.”

Former AMA president Andy Gurman, MD, a delegate for the American Academy of Orthopedic Surgeons, also panned the idea. “The [administration’s] final rule was proffered on November 4; the deadline for late resolutions [at the AMA] was November 10 — 6 days [later],” he said. “By not submitting something as a late resolution, the reference committee process is skirted, which is a disservice to the House [of Delegates].”

The resolution required a two-thirds majority vote for its introduction; it was rejected by a vote of 119 in favor to 353 against.