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Tuesday Feb 19, 2019

Bipartisan Work on Crucial Issues Deserves Support

"It is far better to be alone than to be in bad company."
-- George Washington

[bipartisan agreement concept]

February is a special month for a variety of reasons. It is special for your author, in particular, as the month of my birth. I think I have mentioned this before, but I share a birthday with my father and nephew (and also George Washington!), which has always made our birthdays a major family event.

February also is special for offering the first glimpses of optimism that summer is coming. Pitchers and catchers have reported, and MLB spring training(www.mlb.com) is underway, which means summer is right around the corner. Can we, as a nation, all come to an agreement that Boston should not win any more pro sports championships for at least 10 years?

February also is traditionally when Congress gets down to some serious legislating. The 116th Congress started with a whimper, primarily due to the cloud of the partial government shutdown in January, but in the past few weeks, we have seen a significant acceleration in activity around health care policy. It's hard to predict how aggressive Congress will be on health care during the next couple of years, but there are some areas of bipartisan agreement: prescription drug pricing, insurance reforms and physician workforce training. I think each of these issues could produce bipartisan legislation that is enacted into law during the 116th Congress.

Let's examine each.

Prescription Drug Pricing and Transparency

I approach this issue with a healthy amount of skepticism, but there appears to be a real bipartisan effort underway in both the House and Senate to address the escalating costs of prescription drugs. The momentum began to build in May 2018 when the administration published American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs,(www.hhs.gov) a strategy aimed at decreasing costs and driving greater competition in the brand and generic pharmaceutical markets.

In a weird twist, the issue also was a priority for House and Senate Democrats, who have long cautioned about the negative impacts of high pharmaceutical costs on patients, especially those who are older or low-income. This peculiar alignment between congressional Democrats and the Trump administration has resulted in an environment that, at least for the moment, is bipartisan.

The AAFP has a policy on generic drug pricing, and we recently joined with our Group of Six(www.groupof6.org) collaborators to develop a set of joint principles on the broader issue of rising costs and growing shortages of prescription drugs.(www.groupof6.org)

In the past two weeks, there have been several hearings in the House on the issue, and the administration continues to ratchet up pressure on the pharmaceutical industry. The International Pricing Index Model(www.hhs.gov) that the administration proposed in October is aggressive and would be meaningful. I personally applaud them for putting something bold on the table. To date, we have not heard much from the pharmaceutical industry or its trade association, but that will change Feb. 26 when the CEOs of the world's largest pharmaceutical companies testify before the Senate Finance Committee.

An indication that people are getting serious about this issue is the increasing volume of advertising focused on the pros and cons of pharmaceutical price controls. If you watch CNN, Fox News or MSNBC in the morning hours, you know what I mean. The ads are heating up in frequency and intensity. I still think it is possible for the 116th Congress to do something meaningful on the cost of prescription drugs. The negative impact on individuals and families is just too severe for Congress not to weigh in.

Insurance Reforms

There were two dominant domestic policy issues that motivated voters in the 2018 midterm elections: President Trump and health care -- specifically, protecting people with pre-existing conditions. During the election, Democratic and Republican candidates went out of their way to assure and reassure voters that they strongly supported insurance reforms to protect those with pre-existing conditions. In the past few days, Congress has begun the hard work of moving beyond platitudes toward legislating.

To date, Congress has focused on new insurance products that, thanks to a relaxing of the applicable regulatory framework by the administration, are not required to adhere to the consumer protections established by the Patient Protection and Affordable Care Act. These plans come in two forms: association health plans(www.dol.gov) and short-term, limited duration insurance (STLDI) plans.(www.cms.gov)

Although both products are concerning, the STLDI plans are most alarming. Although they provide a low premium price point for consumers, they are, in my opinion, nothing less than dangerous. The plans can openly discriminate against individuals for health or socioeconomic reasons; impose annual and lifetime caps on coverage; carve out coverage exceptions for pre-existing conditions; and, most concerning, they are not required to offer a comprehensive benefit package. Simply put, these plans do not provide comprehensive coverage. In some cases, they provide no coverage at all.

The AAFP's policy regarding health care for all contains several provisions that are in direct conflict with STLDI plans. The most notable are our positions that insurance plans must cover a defined set of benefits, and that insurance companies should not be able to make coverage determinations on the basis of health condition or socioeconomic factors.

Primary Care Workforce and Graduate Medical Education

The AAFP has made growth of the family medicine workforce a strategic priority through our 25 x 2030 initiative. A key component of our strategy is increasing the availability of graduate medical education (GME) positions dedicated to family medicine.

The AAFP has a comprehensive GME reform policy that provides direction for how we can fundamentally change the legacy GME system, but we recognize that incremental growth is probably the smarter play at the present time. A key to achieving immediate growth in the total number of family medicine residency positions is the reauthorization of the Teaching Health Center Graduate Medical Education (THCGME) program. A second key is increasing the ability of community and rural hospitals to engage in GME activities.

Thanks to AAFP leadership, bills that would achieve both of these goals have been introduced. The THCGME reauthorization bill, known as the Training the Next Generation of Primary Care Doctors Act(www.congress.gov) was introduced by Sens. Susan Collins, R-Maine, and Doug Jones, D-Ala. The Rural Physician Workforce Production Act(www.congress.gov) was introduced by Sens. Cory Gardner, R-Colo., and John Tester, D-Mont. The AAFP strongly supports both bills.

I encourage you to lend your voice to our efforts by encouraging your senators to support the Training the Next Generation of Primary Care Doctors Act through our Fighting for Family Medicine Speak Out resources. After you send letters to your senators, sign up to participate in the Family Medicine Action Network -- a resource that will empower you to be an informed and active participant in our advocacy efforts.

Wonk Hard

On Feb. 13, my friend Niall Brennan, M.P.P., and his colleagues at the Health Care Cost Institute(www.healthcostinstitute.org) published their 2017 Health Care Cost and Utilization Report.(healthcostinstitute.org) Spoiler alert: Health care isn't getting less expensive.

The report examines medical and prescription drug spending, utilization, and average prices, all based on health care claims data from 2013 through 2017 for Americans younger than 65 who were covered by employer-sponsored insurance (ESI). Here are three thing you should know:

  • In 2017, per-person spending reached $5,641, a new all-time high for the ESI population.
  • Spending per person grew at a rate higher than 4 percent for the second year in a row, rising 4.2 percent from 2016 to 2017. This was lower than the 4.9 percent growth from 2015 to 2016, but still high.
  • Out-of-pocket spending per person increased 2.6 percent in 2017.

Posted at 09:00AM Feb 19, 2019 by Shawn Martin

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ABOUT THE AUTHOR



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

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