As the deadline to reach a federal budget agreement approaches, the AAFP and other organizations are fighting the possibility that a congressional showdown could lead to funding cuts to programs that are valuable to primary care training, research and public health in general.
The AAFP and 2,500 organizations in the health, education and workforce sectors recently sent a letter to Congress(static1.squarespace.com) that warns of the possible effects of using sequestration to reduce federal spending. The Academy also sent its own letter(3 page PDF) to House and Senate leaders that lists specific recommendations.
"We are seeing the difficult tradeoffs necessitated by woefully inadequate and historically low levels of spending after years of deficit reduction," the group letter reads.
Discretionary spending not tied to defense could be subject to cuts if no new agreement is reached before the 2013 bipartisan "Murray-Ryan" budget deal expires on Oct. 1. That agreement provided two years of relief from cuts that were required as part of sequestration policy that began in 2010.
The letter asks Congress to minimize cuts to programs outside of national defense by replacing the sequestration policy's arbitrary cuts with a new approach to managing the budget deficit. Congress would need to raise spending limits and prevent major cuts to women's health, early education, transportation safety, law enforcement and veterans.
- The AAFP and 2,500 organizations in the health, education and workforce sectors signed a letter warning Congress about the possible effects of using sequestration to reduce federal spending.
- Discretionary spending could be subject to cuts if Congress does not reach an agreement this month.
- The AAFP urged Congress to continue supporting several programs that either expand patient access to health care or enlarge the pool of primary care physicians.
Primary care physicians have long advocated a need to acknowledge the effects on patients of social determinants of health such as nutrition, education, employment and housing. Specifically, when a patient lacks one or more of these essential components, the individual's physical health can often be adversely affected.
"Real Americans are feeling the negative effects of austerity," the group letter states. "Elementary and secondary education, housing and workforce training programs are unable to meet needs. Scientific discovery has been hindered and public health preparedness and response has been weakened."
Noting that funding for nondefense programs relative to the economy's size is at its lowest level since the Eisenhower administration, the AAFP and the other organizations warn that continued cuts jeopardize essential social needs, including public health. "There is bipartisan agreement that sequestration is bad policy and ultimately hurts our nation," the group letter reads. "It's time to end the era of austerity."
In the letter sent on behalf of family physicians, the AAFP cited specific institutions and programs for which Congress should maintain adequate levels of funding for 2016. Acknowledging that that Congress is unlikely to permanently end the sequestration policy, the AAFP focused attention on programs that either expand patient access to health care or enlarge the pool of primary care physicians.
"We are especially supportive of those programs that aim to reduce health disparities and improve access to care -- particularly for vulnerable and underserved populations," the AAFP's letter reads.
The letter notes that one institution that has proven particularly valuable in enhancing patient care is the Agency for Health Care Research and Quality (AHRQ), which supports research that helps improve clinical decision-making, advance patient safety, decrease medical errors and promote practice transformation. Some legislators have discussed either reducing AHRQ's funding or eliminating the agency altogether and moving its function to another federal agency.
"Terminating or dramatically cutting funding for AHRQ is contrary to the effort to reduce costs in our health care system," the letter reads. "It would be short-sighted and counterproductive to undermine the effectiveness of this critical agency."
The letter also draws legislators' attention to the Health Resources and Services Administration (HRSA), which supports training for primary care but is not assured continued funding at the same level. HRSA also manages the National Health Service Corps, which reduces medical school loans in exchange for working in medically underserved areas.
"At a time when our nation's shortage of family physicians is expected to worsen, we must increase our investment in primary care training authorized under Title VII, Section 747 of the Public Health Service Act," the letter reads.
Also under threat is the Title X Family Planning Program that HRSA oversees. Title X is the only federal grant program that offers comprehensive family planning and related preventive health services. Reducing or eliminating its funding could deny necessary preventive services to low-income women.
"We are troubled that some would aim to prevent access to essential health care services for millions of women and defund important community care sites that provide women, especially low-income women, access to preventive and family planning services," the letter reads. "These essential health care services should not be placed out of reach to low-income and underserved populations."