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AAFP Takes Firm Stand on Health Care Reform Issues
Academy Promotes Health Care Quality, Enhanced Access, Cost Containment
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:
- everyone in the United States will have health care coverage, including catastrophic protection;
- everyone will have a patient-centered medical home, or PCMH; and
- health care will be a shared responsibility among individuals, employers, government, and the private and public sectors.
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."
A Primary Care-Based 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.
Public Plan Option
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
- administrators of the public plan must be accountable to an entity other than the one identified to govern the marketplace;
- the public plan cannot be Medicare;
- the public plan must be actuarially sound;
- the public plan cannot leverage Medicare or any other public program to force providers to participate;
- the public plan should not be required to use Medicare payment rates;
- insurance market rules and regulations governing the public plan must be the same as those governing private plans;
- the public plan cannot be granted an unfair advantage in enrolling the uninsured or low-income individuals, who presumably will be eligible for subsidies in the new marketplace;
- public and private insurers should be required to adhere to the same rules regarding reserve funds; and
- the public plan would need to contribute to value-based initiatives that benefit all payers.
"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.
Primary Care Should Fare Well Under Health Care Reform
Reform Efforts Seen as Positive for Family Physicians
(6/11/2009)
AAFP, Other Physician Organizations Call for SGR Replacement This Year
(6/5/2009)
Senate Finance Committee's Health Reform 'Options Paper' Prompts Swift Academy Response
(5/20/2009)
More From AAFP
Health Care for All: A Framework for Moving to a Primary Care-Based Health Care System in the United States
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