One of the most important jobs for Congress when legislators return to work in 2018 is stabilizing and improving the nation's health care system, the AAFP and other medical organizations said.
A continuing resolution to prevent a government shutdown passed just before Congress recessed this week, but the stopgap measure provided only short-term extensions of critical health care programs. Long-term funding for these priorities -- the Children's Health Insurance Program, community health centers, teaching health centers and the National Health Service Corps (NHSC) -- is "an absolute necessity," said AAFP President Michael Munger, M.D., of Overland Park, Kan., in a Dec. 22 statement.
"CHIP and community health centers are essential to ensuring our most vulnerable families can get the health care they need. Teaching health centers and the NHSC scholarship and medical school loan repayment programs build the primary care physician workforce and bring medical care to Americans living in rural and underserved areas," Munger said.
"Congress must return to Washington in January and immediately begin the work of passing funding legislation that ensures financial stability of all of these programs."
- The AAFP is working with other medical organizations with a shared interest in public health to keep pressure on legislators to act quickly on vital health care issues.
- Key issues are Medicare physician payments, funding for major safety net programs, and maintaining access to care for vulnerable populations.
- The AAFP and other organizations warned legislators about the consequences of using Medicare savings to cover other budget shortfalls.
The AAFP is working with other medical organizations with a shared interest in public health to keep the pressure on legislators to act quickly. Here is a look at some of the other major issues facing Congress in the new year.
Congress planned to gradually increase Medicare payments through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), but another piece of legislation is taking funding away from payments to primary care physicians. The Protecting Access to Medicare Act, passed in 2014, directed HHS to work with physician groups to identify misvalued codes in the Medicare Physician Fee Schedule that could be redirected to pay for undervalued medical services such as primary care.
Instead, however, savings from reduced payments for misvalued services have been used to cover funding shortages outside of Medicare. Congress is considering extending these Medicare cuts for another two years.
Since 2015, Medicare payment increases totaled just 0.7 percent under MACRA, less than half what the legislation called for.
In a Dec. 18 letter(1 page PDF) to House and Senate committee leaders, the AAFP, American College of Physicians (ACP), American College of Surgeons and AMA warned about the consequences of using Medicare savings to cover other budget shortfalls.
"This misguided policy has already eliminated much of the minimal statutory updates Congress enacted as part of MACRA in 2015," the letter stated. "Further application of these polices will result in Medicare physician payment rates at or below pre-MACRA levels."
The sweeping tax bill that President Trump signed Dec. 22 included provisions that are projected to reduce health insurance coverage while leaving privately insured individuals as well as Medicare beneficiaries with higher out-of-pocket medical costs.
The AAFP joined with five other medical organizations to send a Dec. 14 letter(3 page PDF) to leaders in both the House and Senate highlighting the dangers of elements of the legislation.
"We express our increasing alarm regarding tax reform legislation as passed by the House and Senate, and caution that the impact of these policies will be harmful to Americans and our health care system," stated the letter from the AAFP, American Academy of Pediatrics, ACP, American Congress of Obstetricians and Gynecologists, American Osteopathic Association and American Psychiatric Association, which together represent 560,000 physicians and medical students.
One element of the legislation eliminates the individual requirement to obtain health insurance. As a result, the nonpartisan Congressional Budget Office expects the number of uninsured individuals to increase by 4 million in 2018 and 13 million by 2027, and premiums in the individual market to rise 10 percent per year. The organizations warned that these consequences could destabilize insurance markets.
"Without enough healthy people in the insurance pools to subsidize less healthy ones, premiums will have to go up substantially for everyone, if insurers continue to sell insurance at all," the letter stated.
In addition, cuts to Medicare could amount to $25 billion in 2018 -- reducing physician payments by 4 percent -- unless Congress overrides cuts triggered by passage of the tax bill. These cuts affect access for 67 million Medicare patients.
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