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Tuesday May 29, 2018

Bill Would Help Patients With High Deductible Plans

"Summer breeze, makes me feel fine, blowing through the jasmine in my mind."
-- Seals and Crofts

Ah, summer has arrived. I hope each of you had a nice Memorial Day weekend and your summer is off to a good start.
 

[us capitol building at night]

Before I get too far into this week's post, I have a quick and exciting note to share regarding In the Trenches. Starting next week (Tuesday, June 5), In the Trenches will be included in the AAFP's new Fighting for Family Medicine Newsletter. The Fighting for Family Medicine Newsletter will hit your inboxes every other Tuesday and will feature a quick and comprehensive overview of the AAFP's public and private sector advocacy efforts on behalf of you, our members. As I mentioned, my musings and insights will become featured content inside the newsletter, and you also can always fill your In the Trenches cravings by visiting our Fighting for Family Medicine Hub.  

Family Medicine Advocacy Summit

Last week, the AAFP hosted an extremely successful Family Medicine Advocacy Summit  (FMAS). More than 225 family physicians and medical students, from 46 states gathered in Washington, D.C., to advocate on behalf of family medicine, patients and a better health care system.

Participants heard from a great lineup of speakers on the opioid epidemic, practice transformation, health system reform and graduate medical education. The first day of the event featured Sen. Cory Gardner, R-Colo., who discussed his new graduate medical education legislation, the Rural Physician Workforce Production Act of 2018(2 page PDF), and Rep. Brad Schneider, D-Ill., who announced the introduction of his bipartisan bill, the Primary Care Patient Protection Act of 2018(2 page PDF) (H.R. 5858), legislation he introduced with Rep. Elise Stefanik, N.Y.

On the second day, participants conducted more than 250 meetings with their representatives and senators.

On May 22 we awarded the inaugural Champions of Primary Care Awards to Rep. David Rouzer, R-N.C.; Rep. Joe Courtney, D-Conn.; Jason Cooke, who is Rouzer's legislative director to Rouzer; and Maria Costigan, who is Courtney's health policy advisor. The award is designed to recognize members of Congress and staff who have demonstrated leadership in promoting the value to family medicine and primary care to patients, our communities and our nation. We were honored to recognize Rouzer and Courtney and their staff members for their outstanding leadership in establishing the Congressional Primary Care Caucus(2 page PDF).  

FMAS has grown into a must-attend event, especially for those of you who have an interest in health care policy and advocacy. The next FMAS will be held May 20-21, 2019. We hope you will join us in Washington, DC for this great event.

Primary Care Patient Protection Act of 2018

It is not a secret that the costs of health care and health care coverage continue to increase. It is also no secret that many individuals, families and employers are turning to high-deductible health plans (HDHP) as a means of securing affordable coverage for themselves, their families and their employees. According to a report(www.ahip.org) from America's Health Insurance Plans almost 22 million Americans enrolled in an HDHP in 2017, up from 1 million in 2005. All indicators suggest that this rapid growth of HDHPs will continue in individual, small group and employer-sponsored markets.

The AAFP views HDHPs as innovative structures that allow individuals to secure affordable health care coverage, which is important. As I have noted in this space numerous times, health care coverage matters. Individuals who have health care coverage are more likely to have a continuous relationship with a primary care physician, which is a key indicator of health and health maintenance. Put simply, if you have health care coverage and a continuous relationship with a primary care physician, you are more likely to have better health and better maintenance of your health conditions as compared to those who lack one or both.

The Internal Revenue Service defines a HDHP as any plan with a deductible of at least $1,350 for an individual or $2,700 for a family. Consider the real-world impact of high deductibles in the context of a May 2018 Federal Reserve System Board of Governors report entitled Report on the Economic Well-Being of U.S. Households in 201(www.federalreserve.gov)7 that found that "four in ten adults couldn't cover an unexpected $400 expense without selling something or borrowing."

Although HDHPs are playing an important role in expanding access to affordable health care coverage for millions of people, the deductibles associated with the plans are becoming a hurdle to obtaining health care for millions of others. In fact, a CDC report, Financial Barriers to Care: Early Release of Estimates From the National Health Interview Survey, 2016(www.cdc.gov), found that, "Among privately insured adults aged 18–64 with employment-based coverage, those enrolled in an HDHP were more likely than those enrolled in a traditional plan to forgo or delay medical care and to be in a family having problems paying medical bills."

Similar findings were included in a recent study published by West Health(www.westhealth.org) that found that even if people have health care coverage, they are skipping care because they simply can't afford it. Here are some key findings from the West Health study:

  • About 40 percent of Americans report skipping a recommended medical test or treatment, and 44 percent say they did not go to a doctor when they were sick or injured in the last year because of cost.
  • More than 50 percent of people reported experiencing serious financial consequences due to the costs of health care and as a result of health care expenses. Thirty six percent reported that they had to use up all or most of their savings, 32 percent reported borrowing money or increasing credit card debt, and 41 percent say they decreased contributions to a savings plan.
  • More people fear the bills that come with a serious illness than the illness itself (40% percent vs. 33 percent).

These statistics cry out for a policy solution. As mentioned above, Reps. Brad Schneider, D-Ill., and Elise Stefanik, R-N.Y., introduced the Primary Care Patient Protection Act of 2018 (H.R. 5858) on May 18. This legislation aims to assist individuals and families who have secured health care coverage through a HDHP but face obstacles to accessing the health care system due to their deductibles, secure access to their primary care physicians. The bill would create a primary care benefit for all HDHP holders allowing for up to two deductible-free primary care office visits each plan year. If enacted into law, individuals with a HDHP would have access to their primary care physician, or their primary care team, independent of cost-sharing – meaning that the patient could receive a defined set of primary care services prior to meeting their deductible. The company issuing the HDHP to the individual or family would be responsible for providing full payment for the primary care services provided by the physician and cost-sharing requirements would remain in place for all services outside the defined primary care services outlined in the bill.

This legislation is a patient-centered, measured, common-sense approach to assisting individuals and families by creating connectivity with a primary care physician or a primary care team. The AAFP supports this legislation, and we have communicated our support in letters to Stefanik and Schneider.  

Clearly, H.R. 5858 will not address all the cost challenges facing individuals and our health care system, but it is a start. The AAFP is committed to supporting policies that drive greater connectivity with primary care as a means of improving health, but also decreasing costs. We see this legislation and other bills, such as the Primary Care Enhancement Act (H.R. 365/S. 1358), as appropriate vehicles to accomplishing this goal.

Posted at 08:00AM May 29, 2018 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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