Bipartisan Speakers Offer Insight Into Political Climate Surrounding Health Care Reform

According to bipartisan speakers at a recent health care policy briefing held here for the AAFP Board of Directors, the shift from a volume-based to a value-based health care system has put family physicians in a position to drive fundamental and systemic changes in how the nation pays for and delivers health care services. This means family physicians likely will play a larger role in public and private health care sectors, especially as Congress and the White House look to replace the flawed sustainable growth rate (SGR) formula with a more equitable Medicare payment system.

Dean Rosen, the chief health care adviser to former Senate Majority Leader William Frist, M.D., provided the Republican perspective, telling AAFP Board members that ongoing efforts to replace the SGR have created opportunities to promote adoption of the patient-centered medical home and other innovations in care coordination long championed by the Academy.

"You have been huge intellectual leaders in furthering medical homes and accountable care organizations," said Rosen, CEO of Breakaway Policy Strategies.

Chris Jennings, president of Jennings Policy Strategies Inc. in Washington and senior health care adviser to former President Clinton, also said physician payment reform and new health care models provide "huge opportunities" for changing how physicians are compensated. He urged the AAFP to "seed the policies that you want and to put them into law" to eliminate the need for annual SGR fixes and to respond to calls for greater value and slower cost growth.

"Well-constructed health care policy will achieve federal and private savings, no doubt about it," said Jennings. "Budget-produced savings will produce bad health policy. You have to do this the right way."

The policy briefing took place on March 6, only a few weeks after the Congressional Budget Office revised the cost of repealing the SGR from $245 billion to $138 billion, which has renewed hopes that Congress will finally repeal the flawed formula this year. "Only in Washington do we say that $138 billion is something that is on sale," said Rosen.

Nevertheless, Congress has to find offsets to pay for repeal of the SGR, creating the biggest challenge to repealing the payment formula outright, according to Rosen.

The policy briefing occurred as AAFP Board members were preparing to meet with House and Senate members or their congressional staff members on Capitol Hill to advocate policy and programs that are important to family physicians and the nation's health care system as a whole. In their presentation to the AAFP Board, Rosen and Jennings provided perspectives on the prevailing political climate on Capitol Hill.

"I have to acknowledge that the polarization that surrounds the budget and the health care reform debate is unprecedented," said Jennings. "It has a lot to do with structural issues in terms of how Congress has redistricted itself and who they play to in getting re-elected."

Although Republicans and Democrats disagree on how to reduce the federal deficit and debt, they agree that health care costs are a major contributor, making health care important for the major political parties. "Rightly or wrongly, policymakers on both sides of the aisle all reference health care costs as the primary driver of the budget deficit and debt," said Jennings.

In addition, the two health care policy experts said that public and private payers are demanding a greater return on their health care investments. They think they are spending too much on health care, and those health care dollars are crowding out other investments, according to Jennings. "(These payers) will continue to demand change in the health care delivery system regardless if Congress can do anything about it or not," Jennings said.