States Prepare for SCHIP Reductions As Congress Moves to Fill Shortfalls

Congress vowed to fix a budgetary deficit that has left 14 states with insufficient funds to cover shortfalls in their State Children's Health Insurance Programs (SCHIPs), but some states have already made cuts. Georgia froze enrollment in the PeachCare for Kids program, its version of SCHIP, on March 11, shifting money from its Medicaid program to cover the shortfall. New Jersey, Mississippi, and Iowa are projected to exhaust 2007 SCHIP funding by this summer, and Alaska, Illinois, Maine, Maryland, Massachusetts, Minnesota, Missouri, Nebraska, Rhode Island, and Wisconsin are facing SCHIP shortfalls this year. The House Appropriations Committee attempted to address the SCHIP shortfalls on March 15, when it passed a $124 billion supplemental spending bill with $750 million in emergency funding for SCHIP. However, it was expected that wording in the measure—primarily a funding bill for the war in Iraq and Afghanistan—would lead President Bush to veto it. A compromise between House Democrats and Republicans would be needed for the bill to move forward, observers said. For more information, visit https://www.aafp.org/news-now/government-medicine/20070321schipcuts.html.

California Chapters Help Refine Health Reform Proposal

A March meeting between California Academy of Family Physicians (CAFP) members, their peers in primary care, staff members from California governor Arnold Schwarzenegger's office, and leaders in the state legislature may result in reform based on a medical home system. In January, Gov. Schwarzenegger announced a plan that would mandate health insurance for every resident of California. All persons earning more than 250 percent of the federal poverty level would be required to buy insurance through their employers or on the individual market. The cost of insurance for persons earning between 100 and 250 percent of the federal poverty level would be subsidized by a fund made up of fees paid by doctors and hospitals; and children in families earning up to 300 percent of the federal poverty level could participate in California's SCHIP. In March, Schwarzenegger's staff and legislators met with members of the Cognitive Coalition, which comprises the CAFP and state chapters of the American Academy of Pediatrics (AAP), the American College of Physicians, and the American Psychiatric Association, to discuss Schwarzenegger's health reform proposal and legislation introduced by state lawmakers. The Cognitive Coalition has called on the governor to build health system reform based on a medical home system that pays primary care physicians adequately, provides primary and preventive care, and coordinates health care services with other sectors of the community. For more information, visit https://www.aafp.org/news-now/government-medicine/20070314californiareform.html.

Federal Legislation on Health Care Information Technology Introduced

A health information technology bill introduced by Rep. Patrick Kennedy (D-R.I.) would use financial incentives to create qualifying personal health records (QPHRs) for Medicare patients and their physicians. The bill, known as the Personalized Health Information Act, H.R. 1368, is cosponsored by Reps. Dave Reichert (R-Wash.) and Adam Smith (D-Wash.) and contains enhanced financial incentives and patient protection provisions based on input from the American Academy of Family Physicians (AAFP). It focuses on the physician-patient relationship, particularly on giving patients access to and control of their health data while providing physicians with a more accurate minimum data set of information. The legislation also is incentive-based: it establishes a program to make financial incentives available for the creation of QPHRs, and it includes a provision for a personal health record incentive fund to pay physicians at least $3 annually for each patient who uses a QPHR (an increase of $1 from last year's legislation). For more information, visit https://www.aafp.org/news-now/government-medicine/20070314healthitbill.html.

Primary Care Physician Shortage Increases Medically Disenfranchised

The shortage of primary care physicians has left millions of Americans without primary health care services, creating a population of medically disenfranchised individuals who lack access to medical homes, according to results of a study conducted by the National Association of Community Health Centers and the Robert Graham Center in Washington, D.C. Nearly one in five Americans (56 million) are medically disenfranchised, meaning they have inadequate or no access to primary care physicians because of the shortage of such physicians, the report says. The authors of “Access Denied: A Look at America's Disenfranchised” note that the medically disenfranchised come from all income levels, racial backgrounds, and ethnic groups, with nearly 30 percent living in Florida, Texas, and California. Although most of these persons have health insurance, they lack a medical home to address basic health care needs. The report also notes that although the number of primary care physicians has changed very little, the number of specialists in the United States has been growing rapidly. “Primary care specialties have lost their appeal to U.S. medical school graduates, and specific primary care specialties are seeing young physicians look to more lucrative subspecialization,” the authors say. For more information, visit https://www.aafp.org/news-now/professional-issues/20070322disenfranchised.html.

Study Finds Most Physicians Present All Options Despite Moral Objections

Most physicians feel obligated to disclose information about legal but morally controversial medical procedures to patients or to refer them to another physician, according to the authors of a study published in the New England Journal of Medicine in February. However, a significant portion do not profess that same obligation, the authors found. Sixty-three percent of physicians surveyed said they think it is ethical for physicians to express their moral objections to patients regarding a course of treatment or a procedure. Eighty-six percent said they were obligated to present all options for treatment regardless of their personal moral objections, and 71 percent agreed that they should refer the patient to a physician who does not object to the procedure. However, 14 percent of patients, or more than 40 million Americans, may be treated by physicians who do not consider themselves obligated to disclose medical information about procedures to which they object; and 29 percent of patients, or nearly 100 million Americans, may be cared for by physicians who do not think they are obligated to refer patients to other providers for treatment. For more information, visit https://www.aafp.org/news-now/professional-issues/20070312conscientiousobjection.html, or http://content.nejm.org/cgi/content/abstract/356/6/593.

Speakers Say New Orleans Difficulties Expose Health Care System Weakness

The lack of an adequate national health policy has slowed the rebuilding of the New Orleans health care system in the aftermath of Hurricane Katrina, according to economic, health care, and patient advocacy experts speaking at a roundtable discussion on Capitol Hill in Washington, D.C. Robert Phillips, M.D., M.S.P.H., director of the Robert Graham Center, said the two problems with U.S. health policy that Katrina revealed are that the safety net is strained and that we have allowed social disparities to proliferate. Phillips was among three speakers at the discussion, which was sponsored by the Society of Primary Care Policy Fellows and the University of Miami Miller School of Medicine. The speakers noted that the current U.S. health policy undermines the health care system as a whole and leaves Americans at risk of a national breakdown. Rebuilding health care in New Orleans requires a proactive, long-term public policy that recognizes the economics of health care and the public good that derives from investing in the health infrastructure, they said. For more information, visit https://www.aafp.org/news-now/health-of-the-public/20070315hurricanewoes.html.

Match Results Reflect Growing Shortage of Family Physicians

National Resident Matching Program data for 2007 show that the number of U.S. medical school graduates choosing family medicine remains low. After two years of minimal increases in the number of U.S. medical students matching to family medicine residency positions, the 2007 match saw 2,313 positions filled compared with 2,318 in 2006. Also down was the total number and percentage of U.S. students who matched to family medicine: 1,107 (7.8 percent) this year, compared with 1,132 (8.1 percent) in 2006. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20070315matchresults.html.

IHI Launches Initiative to Tackle Chronic Disease Management

The Institute for Healthcare Improvement (IHI) launched an initiative designed to raise awareness about collaborative self-management support, a system of care that promotes patient and provider synergy in the treatment of chronic disease. Nearly 20 organizations, including the AAFP, are joining in the New Health Partnerships (NHP). The AAFP will explore ways to promote collaborative self-management support, increase member awareness of the NHP Web site, and serve as a conduit of information to and from AAFP members. AAFP's Annual Clinical Focus for 2007 is on chronic care delivery, including self-management support of chronic illness. Other organizations actively supporting NHP include the AAP, the National Committee for Quality Assurance, and the Robert Wood Johnson Foundation. For more information, visit https://www.aafp.org/news-now/practice-management/20070316nhp.html, or http://www.newhealthpartnerships.org.

— AFP and AAFP NEWS NOW staff