Advancing Health Care Coverage for All

AAFP PLAN

The plan adopted by the AAFP Congress of Delegates in October 2001:

• Protects all US residents against extraordinary medical costs

• Leaves in place the current insurance market

• Provides funding through a national, broad-based taxing mechanism

• Establishes a public-private oversight body, modeled after the Federal Reserve Board, to monitor and modify the benefits package as needed over time, based on evidence and outcomes data

• Implements a national payment system for covered services that uses a resource-based relative value system with a single conversion factor

• Promotes the expectation that all Americans should have a personal physician—a family doctor— as their usual source of care

ON TO CONGRESS

But how to put these goals before the US Congress? Recognizing the clout wielded by the AMA in Washington, DC, the Academy used its leadership position within the AMA House of Delegates to advance the coverage-for-all message there first.

Academy staff drafted a statement for submission to the US Congress. The AAFP then took the lead in building consensus on a resolution to pose to the AMA and in forging a coalition of specialty group supporters within the AMA House of Delegates.

Aside from the AAFP, signing onto the resolution were the American Academy of Pediatrics, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, (then) American College of Physicians-American Society of Internal Medicine, and American College of Surgeons. Other organizations, including the American Psychiatric Association, testified in favor of the resolution.

The end result: Delegates at the AMA’s December 2002 meeting adopted a resolution calling on the US Congress to enact legislation guaranteeing health coverage for all US residents by 2009. That resolution, as amended by the AMA house, reads as follows:

“Resolved, that our American Medical Association join with interested medical specialty societies and state medical societies to advocate for enactment of a bipartisan resolution in the US Congress establishing the goal of achieving health care coverage through a pluralistic system for all persons in the United States on or before Jan. 1, 2009, that is consistent with relevant AMA policy.”

The AAFP and other specialty groups’ objections to adding the phrases “through a pluralistic system” and “that is consistent with AMA policy” were overruled at the meeting. The revisions reflected some AMA delegates’ concerns about being perceived as promoting a single-payer, government-run insurance system—a prospect the AMA opposes.

The revisions are a moot point, according to AAFP President James Martin, MD, of San Antonio, because whatever is proposed to the US Congress will be revised and negotiated by legislators.

“Even though we didn’t get exactly what we wanted at the AMA, we did get the AMA on record favoring a US Congress resolution on health care coverage for all,” Martin said after the AMA meeting. “This is a major step.”

On the heels of that victory, coalition staff began searching for bipartisan congressional sponsorship to place the sense-of-Congress resolution before federal legislators. That search shows promise, Martin said in a recent interview, and it’s possible the congressional intent measure could be introduced later this fall.

NATIONAL DEBATE

Meanwhile, the AAFP’s coverage-for-all plan waits in the wings. The next step, said Martin, is to “take our plan and compare it with the others that are out there. That allows us to show the strengths and weaknesses.”

According to Martin, discussion at the July meeting of the AAFP Board of Directors focused on four elements of the plan, with some directors concerned about how those elements are perceived—specifically, the taxing mechanism through which coverage would be financed, the plan’s lack of co-payment variability, its noninclusion of hospitalization coverage, and the fact that it establishes a federal mandate and does not allow individuals to opt out of participating.

“But those are exactly the four things that are different from the tax credit plans we see now being pushed,” said Martin. “We’re hoping to generate more discussion of these issues at the national level”—discussion that could later set the stage for introduction of legislation based on the Academy’s plan.

Timing counts. The candidates for US president are addressing health issues in their campaigns, and Academy leaders and other family physicians are already asking presidential hopefuls to articulate their views on access to care for everyone.

“A lot depends on whether the American public has the will to push health care to the front of the line,” said Martin.

Cindy Borgmeyer

AAFP News Department