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CHICAGO -- In prior years, abortion discussions at the American Medical Association (AMA) annual meeting of its House of Delegates would last for a long time, with dozens of people lining up behind microphones to have their say. But this year was different.

"Our policy should be based on science, it should be based on fact, and it should be based on the best available evidence that honors and upholds the value of the patient-physician relationship and the nuance and complexity of medical care," said Kavita Arora, MD, of Chapel Hill, North Carolina, a delegate from the American College of Obstetricians and Gynecologists (ACOG) who was speaking on behalf of the ACOG section council and the Specialty and Service societies. "It is not a one-size-fits-all approach and should not be based on misinformation or disinformation. I strongly urge you to oppose."

Arora was the lone speaker opposing a resolution from Thomas Eppes Jr., MD, a delegate from Forest, Virginia, that asked the AMA to "advocate for availability of the highest standard of neonatal care to [an] aborted fetus born alive at a gestational age of viability," which occurs at approximately 22 weeks' gestation. "This position is not to argue the woman's right to choose ... The decision to abort is still between the patient and the physician," Eppes said. "It does not imply the woman's responsibility for the fetal life, but this resolution places the burden of care on the physician, who now has to care for two patients once the fetus is viable."

Eppes was the only person who spoke in favor of the resolution, which was voted down 476 to 106.

A similar fate befell another resolution from Eppes, this one calling for the AMA's Council on Ethical and Judicial Affairs (CEJA) to "address the rights of the viable fetus in a report to be delivered no later than the 2024 annual meeting."

"Do you believe the fetus is a separate being?" said Eppes, who described himself as pro-choice. "Do the rights and care of a fetus at 22 weeks change if the fetus is in a man-made incubator versus the uterus of a woman? ... CEJA needs to take on this complicated issue and report back."

Arora, again the lone opposition speaker, said she loved the House of Delegates and its use of parliamentary procedure because "it allows us to hear the voice of the minority, which is incredibly important, but to carry through the will of the majority. Time and time again, the majority of this House has spoken, and I hope we can return to other business." The resolution was voted down 470 to 123.

The discussion lasted longer, however, on a proposal from the Medical Student Section to have the AMA support federal financial assistance for seniors to help them buy dental insurance, and to add Medicare coverage for vision and hearing benefits, including eyeglasses and hearing aids. The proposal would have amended a report from the AMA's Council on Medical Service; that report supported finding ways to improve access to dental, vision, and hearing care, but it stopped short of advocating Medicare coverage for these services.

The council cited concerns with Congress's budget neutrality policy -- which requires that any new expenditure be offset by an equal amount of savings or budget cuts -- as one reason why getting new Medicare benefits through Congress would be difficult, especially at a time when the AMA is also advocating for increasing Medicare payments to physicians.

"We deeply appreciate the advocacy of our AMA on increasing physician reimbursement," agreed Justin McGrath, a regional delegate for the Medical Student Section, who was speaking on behalf of the section. "Due to concerns with budget neutrality, our amendment specifically calls for new funding for hearing and vision coverage."

"We believe that our AMA -- the most powerful medical advocacy organization in the U.S. -- can walk and chew gum at the same time," he continued. "We can establish new policies while simultaneously advocating for current priorities. Rather than detracting from advocacy efforts, we believe advocacy for hearing and vision coverage will help galvanize support for legislation that can simultaneously increase physician reimbursement."

Don Cinotti, MD, of Jersey City, New Jersey, an alternate delegate for the American Academy of Ophthalmology who was speaking for the Ophthalmology Section Council, said that the section council appreciated the Council on Medical Service report's cautious approach regarding budget neutrality "because we understood that if they paid for the eyeglasses or contact lenses, they probably would cut some fee to ophthalmology, whether it's cataract surgery or whatever."

"Speaking for our patients now, coverage of eyeglasses and contact lenses would be good if we could guarantee that it's new money and not taken out of the pool," Cinotti said. "I don't think that's possible, so I think our position would still be to oppose this amendment."

David Swee, MD, of Bradley Beach, New Jersey, spoke for the New Jersey delegation in opposition. "It's not that we don't want our patients to have better vision and better dental care," he said. "And in fact, ironically, that would probably lead to lower costs at the hospital and other places because of reduced falls and better health all around. But unfortunately, as CMS [the Centers for Medicare & Medicaid Services] itself will tell you, they can't move one pile of money to another pot of money. So even if we create savings under the hospital designation, it doesn't help us when we're taking care of patients in the office."

But Douglas DeLong, MD, of Cherry Valley, New York, an alternate delegate for the Senior Physicians Section who spoke for the section in support of the amendment, said that although there are issues with the Medicare physician payment system, "we do believe that this amendment addresses that adequately. And we do need to support our seniors in this comprehensive healthcare that is still inadequate at the moment." In the end, the amendment was defeated by a vote of 461 to 159.

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