Proposed Stimulus Package Calls for Strengthening Primary Care Infrastructure

The U.S. House of Representatives is considering an $825 billion economic stimulus package that contains several provisions to support and strengthen the nation's primary care infrastructure, clearly showing that Congress and the incoming Obama administration view primary care as a critical health care component in the nation's overall economic recovery plan. The draft legislation reflects many of the issues and concerns raised by the AAFP in communications sent to the president-elect last month.

"This is a huge step in the right direction," said AAFP President Ted Epperly, M.D., of Boise, Idaho. "It shows that Congress and the Obama administration truly understand what is wrong with the health care system, and they are willing to do something to fix it."

House Democrats unveiled a draft version of the economic stimulus bill on Jan. 15 and hope to have a bill before the full House for a vote no later than Jan. 23. The draft measure provides $20 billion to help physicians adopt health information technology, or HIT, and $600 million to train primary care health professionals, such as primary care physicians, dentists and nurses, while also helping medical students who agree to practice in underserved areas after graduation pay their medical school expenses.

The bill also includes $3 billion for a prevention and wellness fund to better manage and treat chronic and infectious diseases. The prevention and wellness fund would include support for hospital infection prevention programs, immunization programs and evidence-based disease prevention programs.

"This is a clear indication that Congress and the new administration recognize that those investments of money are well worth the dollar amount," said Epperly. "Neurosurgeons are not the type of physicians who provide prevention and wellness. Family physicians are the main doctors, along with our primary care colleagues, who provide wellness and chronic disease management and prevention."

In addition, the draft legislation would provide $1.1 billion for health care research and quality programs to compare the effectiveness of different medical treatments funded by Medicare, Medicaid and the State Children's Health Insurance program, or SCHIP.

Community health centers and Indian Health Service facilities also fare well under the measure. The draft legislation provides $1.5 billion in funding for community centers, including $500 million to increase the number of uninsured Americans who receive health care through the centers and $1 billion to renovate clinics and to upgrade HIT systems in the centers. At the same time, the draft legislation allocates $550 million to the Indian Health Service to modernize older hospitals and health clinics and to upgrade health care technology to improve care for underserved rural populations.

The largest sum of money, $95.6 billion, would increase the federal government's Medicaid contributions to states, allowing states to maintain their Medicaid and SCHIP coverage programs, which are stretched to the limit by low-income individuals who are seeking coverage for their children and families. Other provisions would help people who lose their jobs keep their employer-provided health insurance longer than the current law allows.

In December, AAFP Board Chair Jim King, M.D., of Selmer, Tenn., sent three separate letters to President-elect Obama, urging the incoming administration to increase funding for primary care services and programs and to help physicians adopt HIT as part of any economic stimulus package. The draft economic stimulus package reflects many of the issues and concerns raised by King, clearly demonstrating that the "Academy is being heard," said Epperly.

"Our lawmakers are turning to the Academy and are listening to what the AAFP has to say in terms of what is wrong with the system and what needs to be done to fix it," he said.

The stimulus package represents a down payment on health care reform, a harbinger of major health care reform initiatives that are sure to follow and likely will place a greater emphasis on primary care and prevention as a way to reform the nation's health care system, said Epperly.

"Relief, recognition and respect of what it is that we, as family physicians, do day-in and day-out is being recognized," said Epperly. "Let's all continue to move forward in terms of our patient-centered medical home concepts so that we can better care for America."