February 24, 2022, 7:45 p.m. News Staff — The ongoing pandemic reverberated through a slate of resolutions undertaken by the Reference Committee on Advocacy at the delayed 2021 Congress of Delegates. The resolutions that emerged for adoption this month emphasized the need to bolster patients’ access to primary care while building on the dramatic telehealth expansion borne of the COVID-19 public health emergency.
Members submitted written testimony to the reference committee between Jan. 7 and Jan. 14 and spoke during the virtual hearing of the committee Jan. 22-23.
COVID-19 drove testimony on a resolution from the New York chapter that led the Congress to adopt a substitute resolution calling for the AAFP to “support and advocate that the funding of any future health care system be capable of supporting access to universal, high-quality, equitable and affordable health care without tethering health insurance to employment.”
Members who testified in favor of the original resolution cited data indicating that 55% percent of Americans depend on employers for insurance coverage — a reliance strained by the pandemic’s disruptions to the labor market.
“Thirty million Americans lost coverage during COVID-19 and were placed in challenging positions to find alternative coverage,” the reference committee report said, adding, “members stated that it is immoral to tie health coverage to employment and that delinking coverage would actually save employers money and would result in far less overhead for practices.”
Delegates likewise adopted a resolution from the Idaho and Utah chapters centered on telehealth as means to ensure robust access to primary care. The resolution directs the Academy to petition CMS to cover virtual continuity follow-up care services provided by a patient’s established medical home or usual source of care as if they were in person, even if the patient is temporarily located out of their medical home’s region or state.
“Numerous members testifying in support of the resolution shared personal experiences with how telehealth has strengthened continuity of care for their patients, especially those who seasonally travel to other states for vacation or college, as well as unhoused patients,” the committee’s report said. “Members acknowledged the interstate complexities related to licensure but emphasized that this resolution would allow patients to continue to seek care in their medical home rather than from virtual-only vendors.”
Testimony on a resolution from the Michigan chapter asking the AAFP to petition for the promotion and inclusion of FDA-approved anti-obesity medications, and to advocate for coverage of evidence-based behavioral therapy for obesity, led to adoption of a substitute resolution.
“Members testified that obesity is the second-leading cause of preventable death in the United States, and major insurers need to cover evidence-based treatment and medications so high-risk individuals, who often experience cost and coverage barriers, can have equitable access to treatment,” the report said. Committee members also testified that treating obesity as a chronic disease, rather than treating the resulting diseases from obesity (including diabetes and hypertension), will expand access to needed medications and decrease health care spending in the long term” but said bias should be avoided in such cases.
Ultimately, delegates adopted a substitute resolution calling for the Academy to include Medicare, Medicaid and commercial insurance plan formularies in its advocacy for this coverage.
Also adopted was a resolution from the Washington chapter calling for the Academy to advocate for expansion of FDA approval for physician-prescribed HPV self-collected tests for people eligible for HPV-based cervical cancer screening under current guidelines.
“There was extensive testimony in favor of this resolution and limited written testimony opposed,” said the committee’s report. “Testimony in support of the resolution emphasized the increased screening levels and safety of home screening in clinical trials as well as the importance of self-screening options for patients who have experienced trauma or are more comfortable performing the test at home. Testimony also emphasized the importance of HPV screening to prevent cervical cancer.
“Testimony in opposition to this resolution deferred to the FDA review process for the self-collected cervical screening device. This testimony also disagreed with the need for these devices to be prescribed and indicated a prescription could be a barrier to care for some populations.
The committee also heard testimony on another resolution from the Michigan chapter on nursing home health care reform. Delegates adopted a substitute resolution asking the AAFP to lobby CMS “to explore alternatives to its institutional focus on long-term care by increasing access and funding to Medicaid-covered home- and community-based settings” and to “develop quality-assurance programs for long-term-care facilities, and home-based care, with Medicare and Medicaid reimbursement tied to quality of care.”
“While no opposition was raised during the hearing, it was clarified through testimony that the name change from ‘physician assistant’ to ‘physician associate’ has already taken place in several states,” the committee’s report noted. After the committee heard information about advocacy work underway in the 30 states where name changes are pending, it said the proposed resolution was already covered by existing policy.
A resolution from the Minnesota chapter on self-directed medical care that called for support of tax credits or rebates and health savings accounts also was reaffirmed as current policy.