Thank Goodness Congress Won't Rubber-Stamp This Budget!

Family physicians are the good guys and gals, the docs with the white coats and the friendly smiles. They love their patients, and they love their work -- helping people to stay healthy, going the extra mile to reassure the ailing and taking the time to really know those whom they serve.

But there comes a time when even the nice folks have had enough.

President Bush, in his 2008 budget, had the chance to lead the way toward a solution for the Medicare physician payment mess. Instead, by ignoring the antiquated and deeply flawed payment formula, the president’s proposal puts access to care in jeopardy for a population that greatly needs that care. The budget, presented to Congress Feb. 5, presumes an 8 percent to 10 percent cut in physician payment and lets stand the sustainable growth rate, or SGR, formula.

It’s simple: If you don't pay physicians adequately, at some point, their care will not be available. Family physicians constitute the majority of primary care physicians in the nation, but their ability to continue to provide this care is in peril if their bottom lines continue to shrink. It goes against their very nature, but many FPs will be forced to stop accepting new Medicare patients -- or even to close their practices -- if nothing is done. And as the baby boomers reach retirement age, they add to an already burgeoning population of aging Americans. Who will care for them?

AAFP leaders, members and staff continue the charge to revamp the SGR-based formula so that family physicians are properly paid. But the question remains: Why does this struggle continue? Last year, Congress halted a 5 percent cut in Medicare payments in a last-minute vote. The formula that led to such an egregious cut must be replaced before the final hour this year.

The Bush budget contains additional bad news for family physicians and their patients. For one thing, the budget imperils the State Children’s Health Insurance Program. SCHIP is a cornerstone of a recent proposal by the Health Coverage Coalition for the Uninsured, or HCCU, of which the AAFP is a member. The HCCU recommends expanding SCHIP in an effort to extend coverage to many of the nation’s 9 million uninsured children. Although the president would reauthorize SCHIP, the proposed $5 billion increase over five years would not even sustain the program at its current levels.

Bush’s proposal actually would take health coverage away from children currently covered by refocusing SCHIP only on those children who are in families earning less than 200 percent of the federal poverty level. Currently, 15 states offer coverage to families earning up to 300 percent of the federal poverty level. "Poverty" is defined as $20,650 in annual income for a family of four. In his State of the Union address last month, Bush spoke of helping “states that are coming up with innovative ways to cover the uninsured.” So why make it more difficult for states that are taking care of their youngest residents?

Further exacerbating the threat to access, the Bush budget cuts all funding for family medicine training programs in Title VII of the Public Health Service Act. Although the budget proposes adding 40 community health centers in impoverished counties, who will provide the care if family medicine education withers from lack of funding?

Here's the good news in the midst of all this bad news: Congress will not rubber-stamp this budget. The Academy is pounding the pavement and pounding on doors to make your voice heard, an effort that will make a difference. The AAFP also will continue to work with the Bush administration on family medicine’s priorities. But your legislators need to hear from you personally. To make this easier, the AAFP offers an online resource that will help you find and contact your legislators.

Let’s make this the year the nice guys and gals -- and their patients -- finish first.