Congress has passed a comprehensive health care reform bill that will expand coverage to millions of people and move the country toward a more primary care-based health care system.
"The AAFP commends Congress for passing the Patient Protection and Affordable Care Act," said AAFP President Lori Heim, M.D., of Vass, N.C., in a prepared statement. "While it's been a long and sometimes challenging year for health care reform, today's vote on this important legislation, marks the start of a health care system that meets the needs of Americans."
The House approved a Senate version of a health care reform bill, H.R. 3590, on March 21, sanctioning legislation that will expand health care coverage to 32 million Americans during the next 10 years and provide a 10 percent Medicare bonus for many primary care physicians for the next five years.
The legislation also increases funding for the National Health Service Corps and the nation's community health centers. In addition, the measure reauthorizes Section 747 of Title VII of the Public Health Service Act, the only federal program that provides funds to academic departments of family medicine and family medicine residency programs to increase training of family physicians.
In the area of prevention, the legislation eliminates co-payments for Medicare patients for preventive services and exempts preventive services from deductibles starting Jan 1. New private health insurance plans will be required to provide the same type of coverage within six months, and the provision will apply to all insurance plans starting in 2018.
In the meantime, the legislation sets Medicaid payment rates for primary care services, such as those offered by family physicians, equal to 100 percent of Medicare payment rates, including payments for office visits and immunizations in 2013 and 2014.
On March 19, the AMA announced that it was supporting the health reform bill in Congress, albeit in a qualified way. "The pending bill is imperfect, but we cannot let the perfect be the enemy of the good when it comes to something as important as the health of Americans," said AMA President James Rohack. M.D., in a press release.
Rohack added that Congress also must correct problems with the sustainable growth rate formula, as well as with guidelines for the Independent Payment Advisory Board called for in the new legislation. "The current IPAB framework could result in misguided payment cuts that undermine access to care and destabilize health care delivery," said Rohack.
According to Heim, the AAFP, along with other primary care groups, such as the American College of Physicians, the American Academy of Pediatrics and the American Osteopathic Association, has championed these provisions for a long time and will continue to work to make them permanent. "The AAFP has consistently supported efforts to provide health insurance for all Americans, and to deliver high quality, comprehensive and preventive care in a patient-centered medical home," said Heim.
She also noted that the legislation "opens the door to a reformed health delivery system by paying a bonus for primary care services." That, in turn, "acknowledges the value of primary care physicians."
However, Heim acknowledged that the legislation is not perfect. For example, it does not provide a permanent solution to the sustainable growth rate, or SGR, formula, which sets payment rates for Medicare physicians. The measure also does not provide comprehensive tort reform, something that the AAFP strongly supports.
In addition, although the measure establishes Medicaid medical home demonstration projects and creates a center for innovation at CMS to test the medical home under Medicare, the medical home provisions in the legislation are limited to high-need beneficiaries and, thus, do not go far enough, according to the AAFP.
Other provisions of the legislation include
- it bars health insurance companies from denying coverage to individuals with pre-existing conditions -- the ban takes effect for children six months after enactment, and for all others starting in 2014;
- within six months after enactment, it will prohibit health insurance companies from dropping people from coverage when they get sick;
- it bans health insurance companies, within six months after enactment, from placing lifetime caps on coverage;
- it begins to close the Medicare Part D coverage gap for Medicare beneficiaries who have surpassed their prescription drug coverage limit;
- it requires individuals to carry insurance or pay a penalty that would be the greater of $750 or 2 percent of income by 2016;
- companies with 50 or more employees will be required to help offset the cost of insurance for their employees if taxpayers are footing the bill for those workers' insurance;
- it establishes 50 state-administered insurance marketplaces to allow small businesses and people without employer sponsored coverage to buy insurance that meets new federal standards; and
- it expands Medicaid to cover everyone earning less than 133 percent of the federal poverty level, or $29,327 for a family of four.