Academy Supports Public Plan Option With Qualifications, Says AAFP Board Chair

By News Staff
7/22/2009

The AAFP has reiterated that it supports a public plan option as part of a larger health care reform measure, as long as the public plan is consistent with certain principles.

In a letter to the House Ways and Means Committee, the House Energy and Commerce Committee, and the House Education and Labor Committee -- the three committees responsible for drafting health care reform legislation -- AAFP Board Chair Jim King, M.D., of Selmer, Tenn., said the Academy supports a public plan option if it meets criteria promulgated by the New American Foundation (12-page PDF; About PDFs).

The plan must recognize the value of and promote primary care, including via adoption of the patient-centered medical home.
Administrators of the public plan must be accountable to an entity other than the one identified to govern the marketplace or exchange. In other words, the authority overseeing the marketplace or exchange and responsible for enforcing its rules should not have an incentive to favor a public plan compared with private plans.
The public plan cannot be Medicare.
The 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-like payment methods permanently.
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.
The public plan also would need to contribute to value-based initiatives that benefit all payers.

"The public plan option developed by your committees reflects most of these principles very well," King said in the letter to the three committees. However, the AAFP has "concerns about tying the plan's payment rates to Medicare," he wrote.

The public plan option contained in the tri-committee bill allows physicians to opt out of the public plan without penalty, making participation voluntary. "We would recommend that this be as administratively simple as possible," King wrote.

King also stressed that the AAFP supports a variety of payment mechanisms that can be employed by the public plan -- in particular the patient-centered medical home and care management models.

"In addition, we agree with the emphasis on care that improves health outcomes, decreases health disparities, addresses geographic variations, prevents or manages chronic illness, and is integrated and patient-centered," said King.

At the same time, the AAFP believes the public plan should be able to use innovative payment models to support patient-centered primary care, he said. The legislation says the public plan should consider adopting medical homes as part of new payment and delivery models, a provision endorsed by the AAFP.

Printer-friendly version

Email this page