• In The Trenches

    Encouraging Signs in Washington for Family Medicine

    It would be easy to get caught up this week in the media narratives that usually attend a White House changeover, the recapping of the past four years and the wondering ahead. Easy, that is, unless you’re still processing the past few weeks — or days — and thinking about how much challenge is built into the coming days and weeks.

    photograph of front of White House

    Only a week ago, for instance, CMS issued a pair of reports touting the Trump administration’s efficacy against the COVID-19 pandemic and suggesting that the agency had assembled a strong template for federal action in future crises. But we still remember the blunders, such as the absence of a national plan to supply ventilators, masks and other vital equipment. More recently, there was the announcement that officials would release a quantity of the SARS-CoV-2 vaccines that would have ensured a second shot for all who had received the first – an announcement quickly followed by the revelation that the cupboard was bare.

    “I’m really angry,” family physician Andrew Carroll, M.D., of Chandler, Ariz., told Kaiser Health News in a Jan. 13 story about the issues that have so far hobbled the vaccine rollout, especially for family physicians.

    Carroll told KHN he’d spent some $4,000 to buy an ultra-low-temperature freezer from eBay so he’d be ready to store the Pfizer vaccine. So far, it’s empty.

    “Not only are doctors having trouble getting vaccine for patients,” the story noted, “but many of the community-based physicians and medical staff that aren’t employed by hospitals or health systems also report mixed results in getting inoculated. Some have had their shots, yet others are still waiting, even though health workers providing direct care to patients are in the Centers for Disease Control and Prevention’s top-priority group.”

    We know, and we’re helping family physicians demand action at the state level.

    Yet there’s reason to hope that the incoming administration will improve vaccination efforts while taking strides to improve health care policy as a whole. Ron Klain, President Joe Biden’s chief of staff, was the Ebola czar and knows a thing or two about playbooks and what happens when they’re discarded. His presence in the White House, to paraphrase the new president, could be a big deal.

    On Jan. 14, Biden laid out his “American Rescue Plan” in a nationally televised speech. In what is expected to evolve into a more detailed strategy, he is calling for $400 billion to vanquish the pandemic, including

    • $20 billion for a national vaccination program, with community vaccination centers around the country and mobile units in hard-to-reach areas;
    • $50 billion for testing, rapid test kits, expanded lab capacity and help for schools and local governments;
    • $10 billion to manufacture pandemic supplies domestically, along with $30 billion in Disaster Relief Fund spending for supplies and protective gear;
    • increased federal support to vaccinate Medicaid enrollees;
    • addressing health disparities by expanding community health centers and health services on tribal lands;
    • funding 100,000 health workers to expand the public health workforce; and
    • emergency funding to upgrade federal IT infrastructure.

    That’s appropriately ambitious, and, at least in its outline form, aligns smartly with the Academy’s advocacy. Community health centers? We like them. So do many of our members. Community health workers? We like them.  

    And health disparities, exacerbated by COVID-19? They’re killing Americans.  

    We’ve lobbied Congress to recognize this moment as an imperative to correct health care policy by acknowledging these disparities and working to reduce them. We’ve called on HHS to make a similar reckoning. Biden’s administration is suggesting that it has the will to pay attention to these concerns.

    For too many, it’s already too late. I’m thinking of Susan Moore, M.D., the physician who last month used Facebook to document her own health decline before she died due to complications from COVID-19, and the ways in which systemic racism contributed to her death.

    AAFP President Ada Stewart, M.D., recently recounted the disparities Moore fought against and she urged family physicians to elevate their own awareness.

    “We must continue to fight for our patients and our colleagues,” Stewart wrote. “COVID-19 continues to plague our communities, but we now have a dim light at the end of the tunnel that needs to turn bright as each and every one of our patients receive their COVID-19 vaccine. We must continue to make sure that Black and brown communities no longer fear the health care system that for too long treated them differently. We must advocate for those who are in pain and request pain medication. We have to continue to fight for birth equity for Black and brown mothers and babies. We have to continue to be a voice to fight for health equity for all.”

    The latest Annals of Family Medicine, starting with its potent editors’ statement, echoes this call to action and is a timely must-read.

    Also in keeping with the AAFP’s advocacy, and potentially working to rectify inequity, are the elements of Biden’s overall $1.9 trillion rescue plan that would follow through on one of his campaign pledges by increasing financial support for lower-income enrollees in the Patient Protection and Affordable Care Act.

    A Jan. 16 New York Times analysis noted “a one-sentence provision that could drive billions in federal subsidies to help people afford to buy health insurance.” Additionally, Biden’s proposal would boost tax credits to reduce or eliminate health premiums while capping ACA enrollees’ coverage cost at 8.5% of their income.

    Of this latter part, the Times says, “The proposal does not detail how this would be achieved, but analysts expect the incoming White House to use as a model the legislation that House Democrats passed this summer.”

    The Academy supported that legislation. Among other things, the Patient Protection and Affordable Care Enhancement Act (H.R. 1425) would incentivize states to adopt Medicaid expansion, allow the government to negotiate prescription drug prices and reverse the Trump administration’s rules expanding the availability of short-term limited duration insurance plans (which we do not like).

    That’s a lot for any administration to take on — and a lot for us to keep an eye on as we push Washington to stabilize, strengthen and sustain primary care while better factoring it into this and any future pandemic fight. But we plan to do much more than merely watch, and I see strong opportunities ahead to achieve bold changes.

    Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.

    Related AAFP News Coverage
    AAFP Shares Primary Care Agenda With President-elect Biden

    Additional Resource
    AAFP Advocacy Focus: Health Equity


    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.