January 17, 2018 01:48 pm News Staff – The AAFP is turning up the heat on Congress to give four essential health programs the long-term funding they require, reminding legislators that each one depends on the other three to avoid destabilizing the nation's health care system. Although a new effort would extend Children's Health Insurance Program (CHIP) funding for six years, the other programs have been left out.
CHIP, community health centers, the Teaching Health Center Graduate Medical Education (THCGME) program and the National Health Service Corps (NHSC) must be allowed to continue working in concert, said AAFP President Michael Munger, M.D., of Overland Park, Kan., in a statement issued today.
"No health care program stands alone. Each depends on the success of others," Munger said. "Children and low-income families must be able to see their doctors through CHIP and community health centers. Those centers, like all health care facilities across the country, must have trained physicians. The physician workforce must be built on stable residency training. These four programs are integral to the foundation of our health care system."
The statement comes on the heels of a Jan. 10 visit to Capitol Hill, during which representatives from the AAFP and five other physician organizations -- the American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, American Osteopathic Association, and American Psychiatric Association -- sat down with members of Congress to emphasize the urgent need for stable health program funding.
Individual family physicians can drive the point home by writing a letter or tweeting a message to their own legislators through the AAFP's Speak Out tool.
Congress passed a resolution on Dec. 21 that, ostensibly, funds the four programs through March. These new dollars don't solve the stability problem, though, as several states are expected to exhaust their CHIP funds after Friday. In addition, residents will be reluctant to choose programs at THCs that might become unfunded just two weeks after the National Resident Matching Program results are announced.
Too many patients depend on these programs for Congress to delay action. CHIP makes it possible for nearly 9 million children to receive necessary health care, community health centers serve more than 24 million patients, and more than 11 million patients receive care through the NHSC. And the THCGME program helps secure a stable future for primary care, Munger said, pointing out that more than 80 percent of the program's graduates continue in primary care -- and are three times more likely to practice in underserved communities.
Even if new legislation extends CHIP, patients cannot afford to wait for Congress to ensure the survival of the other programs they depend on.
"Congress cannot disregard their constituents' health security," Munger said, telling legislators they must "act now to pass long-term financing for these vital programs without destabilizing funding for equally important programs that improve the health of all Americans."
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Federal officials should promote payment methods that boost competition in the marketplace and create greater choice for patients. Mergers among hospitals in a single market increase costs for patients and drive up prices for low-value medical services.
"We strongly believe that this is an area where greater competition would benefit patients, physicians, and other health care providers," the letter stated. "Allowing hospitals and health systems to expand their stranglehold on the marketplace is harmful for patients, physicians, employers, and federal and state health care programs."
When a small number of commercial carriers dominate specific geographic markets, they exert inordinate power over consumer choice and payment. For example, Medicare Advantage plans now cover 19 million beneficiaries, yet just two insurers account for 41 percent of this market. On a similar note, Blue Cross Blue Shield accounts for 85 percent of the individual market and 93 percent of the large group market in Alabama.
When large health systems merge, they often shrink their networks, meaning patients may be forced to go out of network to maintain a relationship with their physician. For physicians, greater consolidation means they are often pressured to accept lower payment levels to stay within a particular network.
"The AAFP is deeply troubled by the explosion of mergers between hospitals and health systems," said the letter. "These mergers, in our opinion, are driving up costs, decreasing competition, and creating an escalating arms race in medical technology and costly, low-value medical services. No evidence exists that these mergers are decreasing prices in those marketplaces where they occur."
Another trend that limits access is the rapid rise in high-deductible health plans that dominate the employer-sponsored insurance market. Individuals with these plans often have annual deductibles of $2,000 or more and, as a result, may delay or forgo care rather than pay for a primary care visit out-of-pocket.
"Higher deductibles create a financial disconnect between individuals, their primary care physician, and the broader health care system," the letter noted.
The AAFP has proposed a primary care benefit that would be standard for all commercial policies under which visits to a primary care physician or medical team would not be subject to a deductible or copayment.
Finally, the letter presses the agency to remove legal barriers for patients who want to use their health savings accounts to pay for direct primary care (DPC) arrangements. Current tax law prevents patients from doing so because the IRS considers DPC to be insurance. The AAFP has supported legislation previously introduced in Congress that would change that designation.