AAFP Takes Firm Stand on Health Care Reform Issues

The AAFP has emerged as a prominent player in the health care reform debate on Capitol Hill, staking out positions on several key issues that are designed to improve health care quality, enhance access and contain costs.

The AAFP has long assailed the U.S. health care system as a nonsystem of uncoordinated, fragmented care that emphasizes intervention rather than prevention and the comprehensive management of care. This fragmentation has led to rapidly increasing health care costs, decreased access and less-than-optimal care, say Academy leaders.

In October 2007, the AAFP Congress of Delegates adopted a plan for moving to a primary care-based health system in the United States to address these issues. That plan, known as Health Care for All, was revised and updated by AAFP leaders in 2008. It is based on three core elements:

The Health Care for All plan serves as a framework for the Academy's health care initiatives. It lays out fundamental changes that need to occur to shift the direction of the U.S. health care system to achieve universal coverage while also ensuring that primary care and the PCMH become the basis of the U.S. health care system.

In calling for universal coverage, the document says that goal will only be accomplished "if Congress enacts legislation requiring health care coverage for all with a primary care benefit design featuring the patient-centered medical home." Perhaps just as importantly, the document recognizes that Congress must create a payment system to support the provision of primary care services and the PCMH.

For example, the document says that the payment structure for the PCMH should be based on a blended payment model that encompasses fee-for-service, a care management fee and performance-based payment to "recognize the achievement of quality and efficiency goals through pay-for-reporting and pay-for-performance mechanisms." It also calls for the elimination of financial barriers to accessing primary care and other services provided through the PCMH model, including prenatal care, well-child care, immunizations, basic mental health care, chronic care management and evidence-based preventive services.

As a strong proponent of health care coverage for all, the Academy believes that every resident of the United States, regardless of residency status, should have access to high-quality, affordable health care, according to AAFP President Ted Epperly, M.D., of Boise Idaho.

"People need health care -- without it they live sicker and die younger," he said in an interview with AAFP News Now.

In many cases, the uninsured are unable to pay their medical bills; as a result, their costs are shifted onto taxpayers and those who have insurance. This creates funding distortions that result in higher insurance premiums for insured populations and higher taxes, said Epperly. "This is another reason why it is a good idea to include coverage for everyone to prevent this type of cost-shifting."

The AAFP has been relentless in presenting its views on Capitol Hill, corresponding and meeting with lawmakers to explain how a health care system based on primary care and the PCMH will achieve the simultaneous goals of enhanced health care access, improved quality and lower costs. At the same time, the Academy has repeatedly stressed the importance of having a sufficient primary care physician workforce to support a primary care-based health system.

The AAFP's message of fundamental reform has resonated on Capitol Hill -- several of the Academy's key positions are now turning up in health care proposals put forth by key House and Senate committees.

"We are having a major impact on the health care debate and on the bills that are being written," said Epperly. "This is a result of the work done by our government relations staff; our officers' visits to Capitol Hill; the Connect for Reform
(Members Only) e-mail program movement; our political action committee, FamMedPAC; and the increasing number of family physicians who are communicating with their legislators.

"All of these efforts have coalesced in aligning our messaging at a crucial time," Epperly added.

The AAFP also is quick to respond to proposals issued by House and Senate committees. In late April, the Senate Finance Committee issued a discussion paper on health care reform that included a Medicare bonus of at least 5 percent for primary care physician services for the next five years and a suggested 1 percent increase in the overall physician payment rate in 2010 and 2011.

The AAFP responded quickly and forcefully, arguing that bonuses called for in the discussion paper were inadequate. The AAFP and two other primary care physician organizations -- the American College of Physicians and the American Osteopathic Association -- told the finance committee that in 2010, total Medicare payments for primary care services should be increased by at least 10 percent more than those made to nonprimary care physicians and other providers. The AAFP and the two other groups also recommended increases of an additional 5 percent each year for the subsequent four years.

The debate about whether to include a public plan option in any comprehensive health care reform legislation has emerged as one of the most contentious issues dividing Republicans and Democrats. The Obama administration and most congressional Democrats support a public plan option to give patients more options and to keep private plans honest. Most congressional Republicans oppose a public plan option, saying it will drive private plans out of the market while leading to a single-payer health care system.

The AAFP's Board of Directors has endorsed the public plan option, as long as that plan adheres to several conditions for fair competition, such as those put forth by the New America Foundation, a think tank based in Washington. The conditions are that

Epperly said a public plan option will help "drive health insurance reform" by forcing insurance companies to compete and contain costs.

"It will put the insurance plans on notice by saying, 'If you cannot compete and keep your costs down, then you are going to get bypassed,'" Epperly said.