BY CINDY BORGMEYER
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AAFP delegates and others at the interim meeting of the AMA House of Delegates Dec. 6 - 9 in Honolulu spoke out strongly against recommendations in an AMA council report. It said the AMA should call for the medical care provided under Medicaid to be funded through federal tax credits.
Concerned that the report, as written, did not reflect a pluralistic strategy for Medicaid reform, opponents succeeded in getting an amendment passed. Introduced by the AAFP, the amendment leaves the door open to pursuing alternative funding mechanisms.
The AMA Council on Medical Service report asked the AMA delegates to adopt policy stating "the medical care portion of the Medicaid program should be financed with federally issued tax credits that are refundable, advanceable, inversely related to income and administratively simple for patients."
"We believe one of the problems with the Medicaid program has been its inadequate financing," AAFP President Michael Fleming, M.D., of Shreveport, La., said in an interview after the meeting. "The amendment specifically notes, 'All financing mechanisms should be sufficient to adequately fund the overall costs of caring for this patient population,'" said Fleming. The amendment, which also calls for "adequate reimbursement to physicians caring for such persons," was overwhelmingly passed.
In an unprecedented effort to consolidate support for the amendment, a letter developed by the American College of Physicians with input from the Academy and other groups was distributed to all AAFP members -- some 70 FPs -- at the meeting. The letter noted, "While Medicaid is in need of reforms, it is imperative that we strengthen and not undermine the health care safety net. Although the goals of the CMS report are commendable, we believe it does not propose policy in the best interests of patients, physicians or the AMA."
The letter was signed by the ACP, AAFP, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, National Medical Association and National Hispanic Medical Association. Delegates from all those groups spoke in favor of the amendment on the floor of the AMA house.
"The report was well thought out and represents a very in-depth effort. Our concern is that it limits what we're going to look at as a possible funding mechanism for the Medicaid program," Fleming said.
"One of the things we believe very strongly is that everyone should have access to quality care. Anything that limits access to quality care is not good for patients," he said.
Advocating tax credits as a funding mechanism for health care services isn't new to the AMA. The organization first championed the concept in a 1999 publication, Rethinking Health Insurance: The AMA's Proposal for Reforming the Private Health Insurance System. In May 2003, the AMA published a fine-tuned version of its reform proposal, Expanding Health Insurance: The AMA Proposal for Reform, on which the CMS report was based.
At the interim meeting, the dissenting groups' concern centered on the report's -- and the proposal's -- sole reliance on tax credits. "While tax credits can facilitate expanded coverage, the report is overly optimistic that the federal government will establish tax credits at high enough levels to allow Medicaid recipients to receive comprehensive benefits with nominal cost-sharing," said the groups' letter.
The bottom line, according to Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities, is that such a system would most likely leave too many people vulnerable. "We do not believe that the future of health care financing in this country -- the financing of Medicaid, in this case -- lies solely with tax credits," Ostergaard said in an interview during the meeting. "Although such an approach might work for upper- and middle-income people, we don't believe it offers an adequate safety net for either the working poor or the unemployed."
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AAFP to retain its 16 delegates to AMA in 2004 Delegates at the interim meeting of the AMA House of Delegates adopted an AMA Bylaws amendment freezing the current number of delegates allotted to each constituent association in the AMA house throughout 2004. Thus, the AAFP delegation will retain its 16 delegates and remain the largest delegation in the AMA house through Dec. 31. Delegates at the meeting acted in response to difficulties in accurately assessing both overall AMA membership and specific constituent association affiliations. |
Not too many docs after all
A few pleasant surprises came out of the meeting, said AAFP delegation chair Dale Moquist, M.D., of Wichita Falls, Texas. Delegates adopted several recommendations on physician workforce reform. The action came in response to a report from the AMA Council on Medical Education that called on the AMA to abandon its policy stating a physician oversupply exists or is imminent.
Specifically, said Moquist, delegates adopted a new AMA policy stating there should be no decrease in the number of funded graduate medical education positions. Any proposed increase in GME positions -- overall or in a given specialty -- and in the number of U.S. medical students should be based on a demonstrated regional or national need, said delegates.
Similarly, delegates called for the AMA to collaborate with the public and private sectors to ensure an adequate supply of physicians in all specialties and to develop strategies to mitigate the current geographic maldistribution of physicians.
The delegates modified existing AMA policy by calling for "a sufficient supply of primary care physicians -- family physicians, general internists, general pediatricians, and obstetricians/gynecologists." The delegates also directed the AMA to work with representatives of primary care specialty groups and the academic community to "develop recommendations for adequate reimbursement of primary care physicians and improved recruitment of medical school graduates in primary care specialties."
The AMA is also to collect and disseminate information on market demands and workforce needs to assist medical students and residents in selecting a specialty and choosing a career path. In addition, said delegates, "there is a need to enhance underrepresented minority representation in medical schools and in the physician workforce, as a means to ultimately improve access to care for minority and underserved groups."
Finally, delegates directed the AMA to work collaboratively with state and specialty societies to develop a national consensus on physician workforce policy.
First-time support for Title VII
Perhaps the biggest surprise was the delegates' resounding support for Section 747 of Title VII of the Public Health Service Act. Delegates unanimously adopted a resolution that called for continued funding of Section 747, the only federal program that supports family medicine training programs at both undergraduate and graduate levels. It is specifically designed to increase the number of primary care physicians and other health professionals who care for the nation's underserved.
Delegates also directed the AMA to encourage its members to contact their federal lawmakers and urge them to support legislation including funds for Section 747.
The House recently passed, and the Senate is expected soon to consider, a compromise appropriations bill containing an $82.2 million Section 747 allocation for 2004. That would be a decrease of $10.2 million from the 2003 funding level.
"This is the first time the AMA House of Delegates has supported Title VII, which is so important for funding family practice residencies and departments of family medicine," said Moquist.
The delegates' vote is indeed a milestone, agreed Fleming. "The AMA has now said unanimously that Title VII funding should be increased and that primary care professions are very important."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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