• In The Trenches

    Executive Orders Bring Wins for Family Medicine

    You don’t have to be a close watcher of national politics to grasp that President Joe Biden is moving fast.

    White House and fountain

    Over the past two weeks, his administration has issued a series of executive orders, centering first on COVID-19. Orders broadening access to health care and revising immigration policy have followed.

    You don’t have to be a close watcher of AAFP advocacy to see some of our key goals very favorably reflected in several of these actions.

    The big win: a special enrollment period that will let millions of family medicine patients affected by the pandemic secure coverage under the Patient Protection and Affordable Care Act. The AAFP identified the need for lawmakers to institute this vital flexibility last March as COVID-19 took hold and Americans started losing their jobs, along with their employer-based health insurance. We repeated the call through the rest of 2020, joined by numerous other groups. And it was part of the detailed policy recommendations we offered the incoming administration in December.

    This time, our message got through.

    It’s an especially sweet victory because it was paired with an order calling for scrutiny of federal rules that undermine access to Medicaid or the ACA, including demonstrations and other waivers. This will begin to mitigate the previous administration’s sustained assault on health care access in general and the ACA in particular. Moves such as doing away with navigators and shortening the annual enrollment window shrunk the ranks of insured Americans before the pandemic; egregiously harmful guidance continued even after the election. 

    Statistical readouts vary when it comes to just how many people have suffered economic hardship in the wake of COVID-19, but whatever the increase to uninsured people is, it’s too big. This month and into the spring during the enrollment period, more family medicine patients, rather than distressingly fewer, will again have access to equitable, affordable, high-quality primary care. And more Medicaid beneficiaries will get the care they need.

    As agencies conduct these newly mandated reviews, the Academy will work with the administration to usher out policies that exacerbate health inequities and undermine Medicaid beneficiaries’ access to comprehensive health care coverage. We’ve long opposed work requirements and block-grant financing, for example.

    You can also see the AAFP’s fingerprints on Biden’s executive orders addressing racial and health inequities, which take welcome steps toward another of our urgent advocacy priorities: addressing systemic racism as a critical public health issue. Working to reverse health inequity at the community level is among family medicine’s unique superpowers. The pandemic has tested that strength as never before. Biden’s recognition that it’s a crucial fight — and that the social determinants of health must be acknowledged in federal policy — can only help us as we continue our push to advance health equity.

    To that end, we continue to press the administration to swiftly address COVID-19 vaccine distribution disparities. Last week, we asked the White House and members of Congress to immediately and directly incorporate primary care physicians and practices into vaccination plans. AAFP members must begin administering shots to their patients right now.

    (In a Jan. 29 letter to CMS expressing reservations about several elements of the Medicare physician fee schedule final rule, we again lobbied for much-needed improvements in Medicare payment for vaccines, including those for COVID-19.)

    Finally, this week the president rescinded DHS’ public charge regulation, which penalized immigrants for seeking health care, increasing access barriers and exacerbating health disparities. The Academy had long called for an end to this policy. In other immigration-related executive orders, Biden acted to preserve the Deferred Action for Childhood Arrivals program — which provides work authorization to several thousand health care professionals — and set in motion a review of policies we’ve said imposed limits on the primary care workforce. We’re taking advantage of that open door to specify what else can be done to unstop the primary care pipeline. 

    In fact, it feels as though the administration’s door to primary care might stay open for a little while. I’m excited for us to walk through it rather than pound on it. We can save some of our door-knocking energy for Congress.

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


    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.