As the Patient Protection and Affordable Care Act reaches its one-year anniversary, the AAFP has reiterated its support for the health care reform law, but it also has vowed to continue working to improve the law for family physicians and their patients.
"The AAFP supported this legislation for many reasons, not the least of which is its goal of achieving health coverage for nearly everyone in this country," said the AAFP in written testimony(14 page PDF) to the Senate Finance Committee. "In addition, the (Affordable Care Act) implemented numerous strategies for improving health care delivery and making more available affordable, high-quality care."
The testimony, which was produced for a March 16 hearing on lessons learned during the first year of the Affordable Care Act, pointed to the AAFP's 20 years of efforts to broaden health insurance coverage as part of its Health Care for All policy and noted that many of the provisions of that policy were included in the Affordable Care Act.
However, the AAFP emphasized, "Health insurance coverage alone cannot ensure access to care." Although the health care reform act includes provisions to modernize several federally funded health care programs, including Medicare, Medicaid and the Children's Health Insurance Program, payment levels in these programs must cover provider costs, said the AAFP.
"The Medicare physician payment system, in particular, must be fundamentally reformed to eliminate the sustainable growth rate (SGR) formula that has required repeated Congressional interventions to prevent steep annual payment cuts that threaten access to services."
The Academy also expressed concerns that the Affordable Care Act "might not accommodate privately owned, small and medium-sized physician practices."
"As many as 25 percent of family physicians serve their patients in either a solo or two-physician practice," the AAFP said. "High-quality care can be (and is being) delivered to patients, often in rural and underserved areas, by family physicians practicing alone or with a few other physician and health professional colleagues. Claims that health reform will (or must) lead to 'vertical organization of providers and accelerate physician employment by hospitals and aggregation into larger physician groups,' are without merit and contradicted by the experience of family physicians all over the country."
In addition, the AAFP testified that although the Affordable Care Act contains provisions that acknowledge and recognize the value of primary care, these provisions may not go far enough.
For example, the legislation calls for a 10 percent bonus for Medicare services provided by qualified primary care physicians -- defined as those in family medicine, internal medicine, geriatric medicine and pediatric medicine. However, to qualify for the bonus, 60 percent of a physician's Medicare-allowed charges must be for primary care services defined by evaluation and management codes for office visits, nursing home visits and home visits.
Not only does the AAFP believe that the 60-percent threshold is too high, according to the testimony, but the bonus, which ends on Jan. 1, 2016, needs to be permanent and needs to be higher than 10 percent, said the Academy.
Additionally, the provision in the Affordable Care Act that equalizes Medicaid payments for primary care and preventive health services with Medicare payments for those services lasts for only two years. However, said the AAFP, "It is critical that the Medicaid increase be sustained for medical practices to accept more Medicaid patients. Many physicians have voiced their concern that after two years of increased payment, they will be forced to discharge these patients from their practice in order to remain fiscally solvent."
In summary, the AAFP testimony noted that although the Affordable Care Act has made "important strides" toward ensuring insurance coverage for all Americans and encouraging better health care delivery models, the Academy has identified issues that it will continue to work on, including
- constructive health insurance reform for everyone in the United States;
- changes in health care delivery and payment systems that ensure high-quality, affordable care for our patients; and
- medical education reform that will rebuild the primary care physician workforce.