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Tuesday Jun 25, 2019

Now's the Time: Speak Out to Support Primary Care

"You got that hair slicked back and those Wayfarers on, baby."
-- Don Henley,
Boys of Summer

I wasn't fully prepared for summer's arrival, but alas, it is here. If you've been in the Mid-Atlantic region in recent days, you know that the drenching humidity is a rude reminder that summer has arrived. The start of summer means that baseball season is in full swing. My 2019 Washington Nationals are struggling, but the legend of Max Scherzer is growing. The pitcher recently threw seven scoreless innings with a broken nose and a black eye(www.washingtonpost.com) in a 2-0 win.

Meanwhile, the summer legislative work period in Washington, which spans June and July, is historically the busiest and most productive time of the year for the U.S. Congress. With the 2020 presidential election looming, the summer and fall work periods have the potential to be productive.

At this point, there are two major health care propositions -- one that addresses pharmaceutical pricing and transparency and another that focuses on surprise/balance billing -- in play before the House and Senate. Both issues have bipartisan, bicameral support and, at the moment, support from the White House. During the past month, there have been a number of legislative hearings on these two issues, and the House has approved a set of bipartisan pharmaceutical bills.

The big action kicks off this week when the Senate Health, Education, Labor and Pensions Committee considers the Lower Health Care Costs Act (S. 1895)(www.help.senate.gov), a bipartisan health package introduced by Chairman Lamar Alexander, R-Tenn., and Ranking Member Patty Murray, D-Wash. This is a legitimate legislative proposal that will draw lots of attention from the health care community, including the AAFP. The Academy has submitted comments(5 page PDF) on the draft proposal, and we will be stressing approval of the same key provisions that were included in our letter in the final bill.

In addition to engaging with the HELP Committee and other key congressional committees on these two issues, we will be advancing several family medicine priorities as necessary components of any potential legislative package. At the top of that list will be reauthorization of the Teaching Health Center Graduate Medical Education program and the Primary Care Patient Protection Act.

Teaching Health Centers

Reauthorization and expansion of the THCGME program is a top priority for the AAFP during the 116th Congress. We are actively supporting the Training the Next Generation of Primary Care Doctors Act (H.R. 2815/S. 1191)(www.congress.gov).

The THCGME program was created by the Patient Protection and Affordable Care Act and was reauthorized by both the Medicare Access and CHIP Reauthorization Act in 2015 and the Bipartisan Budget Act in 2018. Current authorization is set to expire on Sept. 30.

As I stated in a December 2018 blog post -- and even as long ago as April 2016 -- the THCGME is one of the most successful health policies of the 21st century. The program has produced more than 900 new primary care physicians (65% are family physicians) and dentists. Of physicians who trained in a THC residency program, 58% practice in a medically underserved or rural community and nearly half receive training in caring for patients with substance use disorders and those who require medication-assisted treatment for opioid use disorder.

H.R. 2815/S. 1191 authorizes the THCGME program for five years and supports creation of new programs, with priority given to those in rural and underserved communities. The bills also would increase annual funding levels from their current $126.5 million per year to $141.5 million per year (S.1191) or even $151 million per year (H.R. 2815).

Primary Care Patient Protection Act

Millions of Americans continue to face escalating costs associated with obtaining health care and health care coverage. For the past decade, policymakers have focused their attention on the impact of health insurance premiums. As a result, we have created a market that is more sensitive to premiums, but we also have seen dramatically increasing out-of-pocket costs in the form of deductibles. According to the Kaiser Family Foundation,(www.kff.org) premiums for employer-sponsored health insurance plans increased 55% between 2008 and 2018, but deductibles jumped an astonishing 212% during the same time period. By comparison, wages rose only 26% during the same period.

An increasing number of employers are turning to high-deductible health plans as a means of decreasing their health care costs. According to the CDC's National Center for Health Statistics,(www.cdc.gov) among adults ages 18 to 64 with employment-based coverage, the percentage enrolled in a traditional health plan decreased from 85.1% in 2007 to 56.6% in 2017. At the same time, the percentage enrolled in an HDHP increased from 14.8% in 2007 to 43.4% in 2018. This number is expected to exceed 50% in the next year or two.

Meanwhile, according to a recent study from the Commonwealth Fund,(www.commonwealthfund.org) more than 40% of all Americans with employer-sponsored insurance currently have a health plan with a deductible that exceeds $1,500 for individual coverage or $3,000 for family coverage. This increase in out-of-pocket expense is causing millions of Americans to make difficult and often consequential decisions regarding their health and health care.

The same study found that adults with an HDHP and a deductible of $3,000 or more reported problems getting needed care because of cost. In fact, 30% reported that they had a medical problem but did not go their physician or clinic because of the associated cost. Additionally, 47% reported that they had at least one cost-related access problem, and 23% reported that they did not fill a prescription because of the out-of-pocket cost.

The Primary Care Patient Protection Act (H.R. 2774)(www.congress.gov) takes a commonsense approach to assisting the millions of individuals and families with HDHPs in obtaining timely care from their primary care physician. This legislation promotes continuity of care, which studies have shown(www.annfammed.org) leads to healthier people and longer lives by providing individuals with HDHPs the ability to secure visits with their primary care physician without cost-sharing requirements.

Take Action

As we approach this critical point in the legislative process, your engagement is vital to our success. Take the time to act: Encourage your elected officials and help the AAFP secure the enactment of these family medicine priorities. Use our Speak Out tool to send letters to your representative and senators today.

If you aren't already, I encourage you to join the Family Medicine Action Network and become a regular advocate for family medicine. Your voice matters!

Posted at 08:38AM Jun 25, 2019 by Shawn Martin

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.