Health Care Coverge for All

Summer 2007

RECOMMENDATION
The American Academy of Family Physicians (AAFP) advocates adoption of a plan to assure health care for everyone. The plan that AAFP proposes for consideration would cover everyone who resides within the U.S. borders and would guarantee basic services and payment of catastrophic health care costs.

Background
Since the 1980s, the AAFP has called for fundamental reform of the US health care system. People without coverage do not receive health care in a timely manner or in the right setting. As a result, they suffer poorer health outcomes. Family physicians believe this country must make a deliberate investment in assuring basic health care coverage for everyone. We believe that a system guaranteeing care would result in a healthier and more productive society.

Specifics of AAFP Proposal

Includes a Basic Benefits Package with services requiring no co-payment (e.g., prenatal/maternity; well baby/child care; evidence-based childhood and adult immunizations and evidence-based periodic evaluation and screening services) and services requiring a 20 percent co-payment (outpatient physician services and visits; services in hospital outpatient department; services in ambulatory centers; outpatient laboratory and radiology services; outpatient mental health services and outpatient prescription medications.)
Protects everyone against extraordinary medical costs.
Leaves the current insurance market in place, including employer-based insurance, individually purchased insurance, medical savings accounts and the choice of opting out of coverage for services other than those assured by the basic benefits package and for costs below the extraordinary costs coverage threshold.
Provides funding through a national, broad-based taxing mechanism.
Establishes a public/private oversight body, a national health board, to determine the extent of coverage under the basic benefits package; ensure that the entity administering the plan does so appropriately, and change the basic benefits package over time based on evidence and outcomes data.
Implements a national payment system for services covered under the plan using a resource-based relative value system with a single conversion factor that is adequate for covered services.
Promotes the expectation that every American should have a personal medical home, which is a medical team led by a physician who integrates the patient’s care and manages medical information.