AAFP Takes Seat at Table During 2009 Health Care Reform Debate

One of the primary roles of the AAFP is to serve as a bold champion for family physicians, and 2009 gave the Academy numerous opportunities to do so. Legislators repeatedly turned to the AAFP to provide feedback and guidance as they crafted health care reform legislation, as well as other legislation that would affect FPs. AAFP leaders made repeated trips to Capitol Hill and the White House to make sure family physicians' concerns were heard, and letters from the Academy and its members blanketed Congress.

Even before the newly elected Obama administration announced that health care reform was going to be a top priority, the AAFP swung into action. Late in 2008, the AAFP laid out an aggressive legislative agenda that included advocating for fundamental payment reform, changes in the Medicare physician payment system to recognize the value of primary care, making health information technology, or health IT, affordable for small- and medium-sized physician practices, and ensuring that everyone in the United States has access to a patient-centered medical home, or PCMH.

In a letter to (then) President-elect Obama, (then) AAFP Board Chair Jim King, M.D., of Selmer, Tenn., addressed the need for inclusion of health care in the stimulus package the administration was planning when it took office in January. The AAFP was gratified when the final stimulus package included a substantial amount for health IT and for primary care physician training.

The Academy's role also was recognized nationally during an early White House health care summit, when President Obama called on (then) AAFP President Ted Epperly, M.D., of Boise, Idaho, and asked him what the views of the physician community were regarding health care reform. Although there were a number of representatives of other physician groups in the room, Epperly was the only physician called on to provide a viewpoint.

AAFP leaders, proverbially striking while the iron was hot, followed up their White House triumph with a Capitol Hill blitz that took their message about the key role primary care and the PCMH would play in any health care overhaul to multiple lawmakers and congressional staff members. Although these types of meetings with legislators and their staff members happen on an annual basis, this year, leaders said that they sensed a change in how their message was received.

Many of the legislators were eager to talk to AAFP leaders about primary care, the PCMH and health care reform. King said he got the unmistakable impression that Congress was open to suggestions to work with the AAFP. Other leaders noted that everyone they talked with seemed to know what the PCMH was and the role family physicians and primary care could play as the foundation for health system reform.

In addition, the AAFP was asked to testify on its views about health reform before two of the committees that drafted health care reform legislation in the House, and AAFP leaders subsequently met with the president at the White House.

The AAFP also launched a key initiative in 2009 that not only helped to keep members updated on advocacy efforts in Washington, it helped to recruit those same members for grassroots efforts to let legislators know family physicians' concerns and suggestions as they worked on crafting health care reform legislation.

Connect for Reform (Members Only) launched in March, and membership in the e-advocacy campaign grew quickly. Blog entries allowed AAFP members to debate health care reform throughout the year, and the site brought members repeated messages from AAFP leaders about what they were busy doing in Washington to advocate for members. (Editor's Note: Connect for Reform has since been renamed Connect for Family Medicine.)

In addition, Connect for Reform engaged members in the fight to ensure that the AAFP's legislative priorities were met. Repeated calls for members to contact their legislators on issues important to family physicians resulted, as of Nov. 24, in more than 8,000 messages to Congress since the beginning of the campaign.

So, as the Academy ushers in 2010, where does the organization stand with its legislative goals? AAFP leaders have repeatedly advocated for payment reform and changes in the Medicare physician payment system, the result of which was an increase in payments to primary care physicians in the latest Medicare fee schedule.

But the even bigger news is the passage of health care reform bills in both the House and Senate. Although the AAFP may not get everything it wants in the final health care reform legislation, members are very likely to see some goals met, and the Academy will continue to advocate for changes it deems necessary.

In addition, 2010 may finally see the repeal of the sustainable growth rate, or SGR, formula, which has threatened cuts in Medicare payments for years. Congress has extended the 2009 Medicare physician fee schedule for 60 days to give lawmakers an opportunity to fix the SGR in a final health care reform bill.

In terms of making health IT affordable, the Obama stimulus package contains $19 billion for health IT, and legislation recently passed by the House would provide funds for low-cost loans to small and solo physician practices to purchase health IT systems.

As for ensuring that everyone in the United States has access to a PCMH, although it isn't known what the final health care reform legislation will contain, it is sure to include many more people in the health care system. In addition, both the House and Senate bills include language expanding the testing and implementation of versions of the PCMH.

As 2010 unfolds, you can rely on the AAFP to continue to advocate for you and your patients to ensure that everyone in the United States can get their health care in a patient-centered medical home, and that family physicians are recognized for the role they play as part of the foundation of health care in this country.