The Academy has sent Congress its federal funding priorities for fiscal year (FY) 2020, emphasizing primary care's vital role in protecting and improving health in rural and other underserved areas and preventing chronic illness nationwide.
In detailed written testimony(5 page PDF) sent March 28 to the House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies, AAFP President John Cullen, M.D., of Valdez, Alaska, said investment in the National Health Service Corps, the Teaching Health Center Graduate Medical Education program and other federal programs would "increase the density of primary care physicians, especially in underserved areas."
The testimony referred officials to a study(jamanetwork.com) published in JAMA Internal Medicine on Feb. 18 that "found that every 10 additional primary care physicians per 100,000 population was associated with a 51.5-day increase in life expectancy -- an increase that was more than 2.5 times that associated with a similar increase in nonprimary care physicians."
If the United States is to realize that strong primary care foundation, HHS agencies across the board must be appropriately funded, the AAFP stated, specifically calling for discretionary budget authority for the Health Resources and Services Administration (HRSA), to be restored to its 2010 level (adjusted for inflation) of $8.56 billion, to ensure adequate funding for HRSA programs that specifically bolster primary care, especially family medicine.
- The AAFP sent testimony about its federal funding priorities for fiscal year 2020 to the House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies on March 28.
- Noting that an increase in the number of primary care physicians is associated with increased life expectancy compared with a similar increase in nonprimary care physicians, the AAFP called for investments in the National Health Service Corps, the Teaching Health Center Graduate Medical Education program and other federal programs that boost the primary care workforce.
- The Academy's recommendations also include $460 million in budget authority for the Agency for Healthcare Research and Quality and $305.9 million for the Office of Rural Health Policy.
"This pressing need for a greater investment in programs to support primary care and family medicine motivates the AAFP to strongly urge the committee to prioritize the following programs within those HHS agencies," the Academy added.
Failure to fund these agencies would be tantamount to inaction and would likely lead to an "increase in morbidity and higher premature mortality" for Americans, the Academy warned.
National Health Service Corps: $120 million in discretionary funding
The National Health Service Corps (NHSC), which HRSA administers, "plays a vital role in addressing the challenge of regional health disparities arising from physician workforce shortages," the Academy reminded the committee.
The AAFP supported continuation of the NHSC's 2019 budget of $120 million to expand treatment of substance use disorder and strongly urged Congress to extend the agency's trust fund, which expires at the end of the current fiscal year.
Primary Care Training and Enhancement Program: $59 million
The Academy called for an increase of $10 million for HRSA's Primary Care Training and Enhancement program in FY 2020, bringing the total for the program to $59 million.
Rural Residency Planning and Development Program: $15 million
HRSA's Rural Residency Planning and Development Program supports the development of new rural residency programs or rural training tracks in family medicine, internal medicine and psychiatry.
"Most of the 62 million people living in a rural community or county depend on a family physician for their health care," the Academy said. "The AAFP welcomes this important initiative to address rural training challenges as a way to reduce health care disparities facing rural communities."
Office of Rural Health Policy: $305.9 million
The Academy's testimony sought to strengthen other aspects of rural health, as well. Citing CDC data(www.cdc.gov) on rural health challenges and disparities, the AAFP strongly supported increased investment in the Office of Rural Health Policy. Its programs,(www.hrsa.gov) the Academy said, "work to reduce the unique obstacles faced by physicians and patients in rural areas."
The requested funding, the AAFP added, should support rural outreach network grants, rural health research, state offices of rural health, telehealth and other programs recommended by the National Rural Health Association.
CDC: $7.8 billion
To help support family physicians' efforts to prevent and control chronic diseases and associated risk factors and to reduce health disparities, the AAFP recommended that Congress approve
- $1.2 billion or more for the CDC's National Center for Chronic Disease Prevention and Health Promotion,(www.cdc.gov)
- $799 million or more for the National Center for Immunization and Respiratory Diseases,(www.cdc.gov) and
- $50 million to conduct public health research into firearm morbidity and mortality prevention.
CMS Program Management: $3.7 billion
CMS, the Academy said, should be provided "at least $3.7 billion for program management to allow the agency to manage the complex implementation" of the Medicare Access and CHIP Reauthorization Act.
AHRQ: $460 million in budget authority
Because primary care research is a core function of the Agency for Healthcare Research and Quality (AHRQ), funding that office is a priority for the Academy. Likewise, without increased resources, Practice-based Research Networks (PBRNs) -- "which cultivate, conduct, support, promote, disseminate and advocate for primary care research in practice-based settings" under AHRQ's aegis, the Academy wrote -- could face the same fate as the National Guidelines Clearinghouse, which shut down last year when it lost funding.
"The AAFP strongly urges the committee to increase AHRQ funding in order to protect the PBRN and restore the research initiatives to optimize care for patients with multiple chronic conditions, as well as dedicated funding for AHRQ's Center for Primary Care Research."
A separate letter(2 page PDF) to the subcommittee, dated April 2 and co-signed by the AAFP and 22 other organizations, asked for $5 million for AHRQ's Center for Primary Care Research.
Title X: $286.5 million
Because Title X of the Public Health Service Act remains crucial to preserving the physician-patient relationship,(1 page PDF) the Academy asked for "adequate funding to support Title X clinics, which offer necessary screening for sexually transmissible infections, cancer screenings, HIV testing and contraceptive care."
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