Obama Rallies Support for Health Care Reform During a Joint Session of Congress

Family physicians have been on the front lines in dealing with the problems of the current health care system, including skyrocketing coverage costs, fragmentation of care and a payment environment that values procedures over prevention, said AAFP President Ted Epperly, M.D., in response to a Sept. 9 speech by President Obama to a joint session of Congress.

AAFP Board Chair Jim King, M.D., of Selmer, Tenn., one of two AAFP members in attendance in the gallery during the speech, said the address was "well received" among members of Congress, but for the most part, the president reiterated points he has made previously.

Obama unveiled the broad outlines of a health care reform plan that he said would provide more security and stability to people who have insurance and would extend coverage to those who currently are uninsured. In addition, the plan would slow the growth of health care costs for families, businesses and government.

"If you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid or the Veterans Administration, nothing in this plan will require you or your employer to change the coverage or the doctor you have," Obama said.

He noted that his plan would strengthen the existing system of health care coverage by outlawing discriminatory practices by insurance companies. "Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition. As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most."

Insurance companies will no longer be able to "place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime," he said. "We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick."

Obama's plan also would require insurance companies to cover routine checkups and preventive care, such as mammograms and colonoscopies. "There's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse," Obama said. "That makes sense, it saves money and it saves lives."

The plan also would create a new insurance exchange or marketplace, in which both individuals and small business could shop for health insurance at competitive prices. And for individuals and small businesses who cannot afford the lower-priced insurance provided by the exchange, "we will provide tax credits, the size of which will be based on your need," Obama said.

The exchange would not take effect for four years, but in the meantime, "for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill," Obama said.

Under Obama's plan, individuals would be required to carry basic health insurance, and businesses would be required to "either offer their workers health care or chip in to help cover the cost of their workers," said Obama. He added, however, that there would be hardship waivers for individuals who cannot afford coverage and for small businesses that cannot afford to provide insurance.

"The American Academy of Family Physicians commends President Barack Obama for urging action this year on health system reform," said Epperly in a prepared statement. "As frontline physicians who have seen the impact of our current broken system on our patients, we agree that the time for reform is now.

"Affordable health coverage must be available to all Americans, regardless of pre-existing conditions or medical history. Health insurance must continue to cover patients after they become sick. It must be available regardless of a person’s income or job status. The reform envisioned by President Obama works toward those goals," said Epperly.

King was pleased that Obama called for insurance industry reform in his plan. "In our offices, it is the private insurance companies that are the hardest to deal with and to make sure we get care to our patients," said King. "We have to have private insurance reform. I heard agreement in the Capitol on both the Democratic and Republican sides that that needs to happen."

King also was pleased that Obama addressed medical malpractice reform via alternatives to litigation.

"I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs," said Obama during his speech. "So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine."

"The AAFP has long supported caps on non-economic damages," noted King, "but we have also supported bills to provide alternatives to litigation."

Obama's plan also calls for the establishment of a commission to study ways of making Medicare more efficient and to encourage the adoption of best practice modalities by the program. King noted that such a commission would need to include the appropriate people from the community at large, as well as appropriate representatives from primary care.

King also endorsed Obama's proposal for a health insurance exchange and his calls for employer and individual insurance mandates. "That is the only way we can get to universal coverage," said King. "If we don't have some type of mandate, it can't happen."

Janet Albers, M.D., a professor of family and community medicine at Southern Illinois University School of Medicine in Springfield, and the other AAFP member who attended the speech, described Obama's address as "inspiring."

"I thought it got the message out," said Albers. The president was emphatic that health care reform was a problem he and his administration was determined to move forward on, she added.

In his speech, Obama reiterated his support for a not-for-profit public option as part of the insurance exchange. Such an option would only be for people without insurance or for small businesses who want to offer their employees health insurance at a competitive price, according to Obama.

However, the public plan option will only work if businesses are required to provide insurance for their employees, said Albers. Without some type of mandate, businesses "will refer their patients to the public option," she said. "I am not sure it would then be feasible."

Although Obama said most of his plan could be paid for by reducing waste and inefficiency in Medicare and Medicaid programs, Albers was concerned about how far this could go.

There is waste in the system, she said, but much of it is a result of people who receive fragmented care, often in emergency rooms instead of via primary care. Making primary care available for these patients would avert many emergency room visits and reduce costs, she noted.