Primary Care, Medical Homes, Patient Choice Underpin Bill

A more robust role for primary care, increased use of personal medical homes and greater patient choice in health plans form the foundation of a universal health care coverage proposal that likely will be among the first bills introduced in the 110th Congress in January. Academy staff members are reviewing the proposal to determine the potential effects on primary care and family medicine, should the plan become law.

The proposal, dubbed the Healthy Americans Act (PDF file: 166 pages / 289 KB. More about PDFs.) by its author, Sen. Ron Wyden, D-Ore., contains wide-ranging provisions that place responsibility for buying health insurance on individuals, establish school-based primary care health centers, and revamp Medicare to emphasize medical homes and provide care management fees.

"We're here because it is time to fix health care," said Wyden in a Dec. 13 news release announcing the plan. "Fixing health care is not as complicated as one might think. Start by making care more affordable. … Get citizens good quality outpatient health care so they don't go to hospital emergency rooms. Reward prevention -- health care, not sick care."

The proposal calls for states to establish Health Help Agencies, or HHAs, that would educate residents about the private health plans in which they can enroll, administer enrollment and assist income-eligible enrollees with sliding scale premium reductions. Employers no longer would buy insurance on behalf of their workers, although they still would be responsible for contributing to the system overall. Instead, businesses would increase employee wages by the amount that would have gone to insurance premiums and each worker would buy his or her own plan. Low-income workers would qualify for subsidies to help them pay premiums.

In addition, the proposal promotes primary care for Medicare patients by creating a primary care management fee for physicians who are designated as a beneficiary's medical home. Medicare also would be required to provide a chronic disease management program by 2008. The program would provide a chronic disease management payment to any physician who manages patients with any of the five most prevalent chronic diseases, as identified by the HHS secretary.

Wyden's plan also calls for establishing school-based health centers in which primary care services -- including health assessments, diagnosis and treatment of minor acute or chronic conditions, and mental health services -- would be provided by an "appropriately credentialed" individual, such as a physician, nurse practitioner, physician assistant or mental health professional.

Other provisions include authority for the HHS secretary to negotiate Medicare Part D prices with manufacturers of prescription drugs and provisions that let Part D enrollees switch plans if they reach the coverage gap.

Calls for health system reform have grown in recent months as polls increasingly indicate that the American public sees health care as a top priority for the next Congress.

A poll (PDF file: 5 pages / 100 KB. More about PDFs.) conducted Sept. 11-13 by the AAFP found that 68 percent of voters said they thought the health care system wasn't working for most Americans, and 26 percent of voters ranked health care as the first or second highest priority for Congress and the president.

An Oct. 4-10 Harris poll found that 29 percent of self-proclaimed "likely voters" said health care would "have the biggest impact" on their voting decisions, ranking even with "keeping America safer" and as more important than the "war on terror" and "Iraq."

In a public health confidence survey, (PDF file: 12 pages / 138 KB. More about PDFs.) released in November, the Employee Benefit Research Institute found that 19 percent of Americans listed health care as an issue that is "most critical today," while 17 percent listed "the war," 16 percent chose "energy and gas prices," and 14 percent chose "terrorism."