Senate Passage of Bill Moves Congress Closer to Enacting Health Care Reform

The Senate passed a health care reform bill on Dec. 24 after more than three weeks of heated debate. The landmark measure seeks to strengthen the U.S. health care system by expanding coverage and enhancing access to services, while also bolstering the nation's primary care physician workforce.

"This bill is a good start," said AAFP President Lori Heim, M.D., of Vass, N.C., in an interview with AAFP News Now. "It does many of the things that we have hoped for. It increases the number of patients who will have insurance and is consistent with our Health Care for All policy."

In a prepared statement, AAFP Board Chair Ted Epperly, M.D., of Boise, Idaho, said the Patient Protection and Affordable Care Act (at the THOMAS Web site, type "H.R. 3590" in the search box after selecting "Bill Number") contains provisions that will prevent private insurance companies from denying coverage to people because of pre-existing conditions or dropping patients from coverage if they get sick.

"With 46.3 million uninsured Americans and another 25 million who have inadequate coverage, the possibility of a bankrupting illness has shadowed people of all ages and in virtually all income brackets for too long," Epperly said. "This bill represents important progress toward removing that threat."

In addition, said Epperly, the legislation "will expand Americans' access to preventive, primary care and -- through national demonstration projects -- help establish the validity of the patient-centered medical home, a cornerstone for a meaningful, comprehensive health care system."

At the same time, he noted, "It will begin to build up our nation's primary care physician workforce by improving payment to primary care physicians."

The legislation would provide a 10 percent bonus for five years for physicians who provide more than 60 percent primary care health services in their practices, a provision that Epperly called "an important step toward signaling to medical students that the nation is committed to investing in primary care."

According to both Heim and Epperly, however, more needs to be done.

"We have a primary care physician shortage, and we need to look at increasing the numbers of family physicians," Heim said.

Although she described the bonus payment for primary care as a positive starting point, "it is not going to be substantial enough to really change medical school students' interest in primary care."

The AAFP has called on Congress to make permanent the primary care bonus payment in the legislation and has urged that it apply to physicians who provide 50 percent primary care health services, not 60 percent, to allow more primary care physicians to qualify for the bonus.

In addition, the legislation does not contain a permanent fix for the sustainable growth rate formula, which has triggered steep reductions in Medicare physician payment rates during the past eight years, although the Senate has pledged to work on this issue.

The bill also does not provide comprehensive tort reform, something the AAFP has long championed. It does, however, include funding for states to explore alternative dispute resolution systems.

Nevertheless, Epperly praised elements in the bill that he said are positive for primary care, especially additional provisions aimed at strengthening the nation's primary care workforce.

For example, the legislation would create a national health care workforce commission and would make improvements to the primary care student loan program. It also would increase funding for the National Health Service Corps and would, in addition, reauthorize Section 747 of Title VII of the Public Health Service Act, the only federal program that provides funds to academic departments and programs to increase the number of primary care health professionals.

"Altogether, these (provisions) will help rebuild the foundation on which a stronger primary care physician workforce can be restored," said Epperly. "They will ease the cost of medical education for students wanting to become family physicians and strengthen the educational programs that encourage medical students to become family doctors."

Senate passage of the Patient Protection and Affordable Care Act means House and Senate conferees will start to work on reconciling the House- and Senate-passed versions of health care reform legislation. The AAFP, for its part, will continue to "communicate with members of Congress so that they are aware of our concerns and, specifically, with suggestions on how the legislation can be improved," Heim told AAFP News Now. "The fight over health care reform is far from over."

Epperly echoed that sentiment in his statement, saying the AAFP would continue to work with lawmakers to address the issues that concern America's family physicians.

"We must move forward with health care reform that provides health care security for patients, an adequate physician workforce to meet their needs and a delivery system that enables physicians to provide high-quality health care," he said.