Delegates Tackle Public Policy Issues, Including Rural VA Offices, Medicare Part D

The AAFP Congress of Delegates on Sept. 27 in Washington, D.C., championed public policy measures that ranged from rural services for veterans to the care of undocumented immigrants. This summary hits a few highlights of delegates’ public policy efforts.

Rural services for veterans. The Academy should work with the National Rural Health Association and the National Association of Community Health Centers to seek a demonstration project in which rural FPs would contract with the Department of Veterans Affairs to provide services to veterans, the delegates decided.

The resolution noted the agency’s interest in establishing rural clinics, and some AAFP members issued a warning. “We share concerns that the VA rural clinics should not be duplicative” of family physicians’ services in rural areas, said Dennis Saver, M.D., of Vero Beach, Fla., immediate past president of the Florida AFP.

“Too many of my veterans have to decide whether to go all the way to the VA hospital in Tucson, 80 miles away, or come to me,” delegate Carlos Gonzales, M.D., of Patagonia, Ariz., said as he encouraged adoption of the measure.

Medicare Part D. During reference committee testimony on Sept. 26, delegates testified on a resolution on reforming and simplifying Medicare Part D. One AAFP member said, “This system is an absolute travesty. Our seniors, our patients are suffering” from problems with Part D. Another AAFP member countered, “Part D has helped my patients get the medication they need.”

Delegates asked the AAFP to seek simplification of Part D drug selection choices and payment plan, including provisions for waived or low fixed-price copays for generic drugs, shared formularies for generic drugs, and online access to Part D formularies at a single CMS Web site.

Care of undocumented immigrants. H.R. 4437, the Border Protection, Anti-Terrorism and Illegal Immigration Control Act, which passed the U.S. House of Representatives Dec. 16 but has not come to a Senate vote, would make it a felony to transport or provide assistance to undocumented immigrants, said a resolution from the New York State AFP.
Delegates called for the AAFP to support legislation whereby physicians could provide medical care “without fear of arrest or criminal prosecution, whether or not the patient is an American citizen, immigrant or undocumented immigrant.”

Delegates referred a related resolution, one on the criminalization of medical practice, to the AAFP Board of Directors. The measure, delegates noted, could apply to overprescribing, end-of-life care, services for undocumented immigrants and other measures legislators may identify as crimes. “We do not want lawyers to legislate what we do,” said one AAFP member. However, other testimony noted the need to have states define medical practice, and the delegates asked the Board to study the proposal.

Foster care. The delegates added a reference to foster parents in an AAFP policy that already covered adoptive parents. The revised policy says the Academy should support “legislation which promotes a safe and nurturing environment, including psychological and legal security, for all children, including those of adoptive and foster parents, regardless of the parents’ sexual orientation.”

Standardized contracts. Colorado S.B. 198, passed by the Colorado legislature but vetoed recently by the governor, would have mandated a standardized contract for all Colorado health plans and physicians. “It will come back next year,” alternate delegate Larry Kipe, M.D., of Craig, Colo., told the reference committee.

Delegates urged the AAFP to use S.B. 198 and the AMA Model Managed Care Contract to assist constituent chapters that wish to pursue the use of such contracts by insurers and physicians.