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Tuesday May 14, 2019

New Primer Lays Out AAFP Approach to Health Care Reform

The AAFP has long recognized the critical importance of having meaningful health care coverage that includes a usual source of care, such as a family physician. Policy supporting it dates back three decades, and it is understood that this simple but elegant principle is the bedrock of better health for our patients, delivered at a reduced cost throughout the overall health care system.

[person carrying three binders marked reform]

In light of the changing dynamics in the delivery of care and an awareness of calls for reform in the face of skyrocketing costs, the Academy has been developing policy for the past several years with the goal of identifying and evaluating potential reform solutions.

The first step was an analysis of current international models of health care coverage. This was presented to the 2017 Congress of Delegates in Board Report F,(37 page PDF) which provided a comprehensive look at multiple delivery and financing structures seen around the world. It provided a strong foundation to build on but stopped short of drawing conclusions or recommending that any one model should be considered for the United States.

Recognizing the importance of holding this discussion at the national level, as well as the Academy's need to have policy and direction with which to engage in the conversation, the AAFP Board of Directors took the next step in the process. Thanks to hard work at every Board meeting during late 2017 and throughout 2018, policy dating back to 1989 has been reimagined as new policy for health care coverage for all that is based on recognizing the importance of a strong foundation of family medicine and primary care. The Board gave thoughtful consideration and devoted extensive discussion to the challenges that any reform efforts will face, as well as to opportunities to improve the health of our patients, our communities and the nation as a whole.

This new policy calls out and incorporates elements of the various international models noted in Board Report F, but, like the report, it stops short of singling out one model as "the solution." This is intentional, and it gives the policy its ultimate strength.

As we are seeing in the current national conversation around this issue, many groups are floating ideas to reform health care. We have all heard of the "Medicare for All" proposals. Under House legislation that is being developed, those without coverage could buy into Medicare, but the majority of Americans would continue to rely on employer-based coverage. Other efforts seek to strengthen the Patient Protection and Affordable Care Act as a foundation for universal coverage. And we are hearing that even more proposals will come after the 2020 election.

Recognizing the lack of consistent dialogue around health care reform, the Board made the important decision to create a policy and a document that acknowledge the need for flexibility in our conversations and advocacy efforts. This means that as one model or combination of models begins to emerge as the uniquely American solution, the Academy will be poised to further those efforts -- and, importantly, it will allow the voice of family medicine to help shape the outcome.

The policy was presented to the 2018 Congress of Delegates in the form of Board Report G(622 KB PDF) and was adopted. That same Congress adopted a resolution calling on the AAFP to make both Board reports available to help increase family physicians' awareness of current policy and to provide information and background on the various options for health care reform.

In response, the Academy commissioned a primer that includes information from both reports and provides a discussion of the AAFP's future approach to health care reform. This primer, "Health Care for All: Moving to a Primary Care-Based Health System in the United States," is now available in digital format for members and chapter staff. It will educate and inform members about the AAFP's efforts and provide a thorough understanding of current and future engagements on health care reform. In addition, a series of educational presentations at AAFP conferences throughout 2019 will address the topic.

Nationally, health care reform has taken center stage. The importance of meaningful coverage for all built on a primary care foundation has never been more apparent. The AAFP's policy will help us strongly advocate for this critical human right on behalf of our members and their patients .

Michael Munger, M.D., is Board chair of the AAFP.

Posted at 08:25AM May 14, 2019 by Michael Munger, M.D.

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