Academy Builds Coalitions for Health System Reform

PRINCIPLES FOR REFORM

AAFP was instrumental in leading a group of medical associations, including the American Academy of Orthopaedic Surgeons, American College of Cardiology, American College of Emergency Physicians, American College of Obstetricians and Gynecologists, American College of Osteopathic Family Physicians, American College of Physicians, American College of Surgeons, American Medical Association, and American Osteopathic Association, to formulate 11 principles for health system reform, including access to health care, medical liability reform and management of health care costs.

The group first came together in November 2004 at the behest of the AAFP under the leadership of then-President Mary Frank, MD, of Mill Valley, Calif, to create a plan for health care reform. The result is “Principles for Reform of the US Health Care System,” which represents the first time so broad a swath of medical specialists have spoken with a unified voice, according to AAFP President Rick Kellerman, MD, of Wichita, Kan.

“Doctors want Congress to take action on health system reform this year,” he said. “Physicians are coming together to support these principles because they want the best care for their patients, and if these principles are adopted, patients will be the main beneficiaries.”

Moreover, the principles offer a solid foundation on which Congress can craft comprehensive health system reform, according to Frank, who chaired meetings of the organizations.

“Congress doesn’t have to worry about infighting among the groups who support the principles, especially since the groups represent the majority of physicians in the United States,” she said. “Not only are they (the principles) comprehensive, but they don’t put the onus of the solution on any one group. That makes it more palatable to a legislator—that we say ‘We’re willing to step up to our part of responsibility, you step up to your part and we expect others to assume their part of the responsibility.’”

AAFP EVP Douglas Henley, MD, agreed. “The group represents a huge percentage of the physicians in this country,” he said. “It recognizes the need for system reform, not just providing health care coverage to people.”

According to the principles

• Health care coverage for all is needed to ensure quality of care and to improve the health status of Americans.

• The health care system in the United States must provide appropriate health care to all people within US borders, without unreasonable financial barriers to care.

• Individuals and families must have catastrophic health coverage to provide them protection from financial ruin.

• Improvement of health care quality and safety must be the goal of all health interventions, so that we can assure optimal outcomes for the resources expended.

• In reforming the health care system, society must respect the ethical imperative of providing health care to individuals, the responsible stewardship of community resources and the importance of personal health responsibility.

• Access to and financing for appropriate health services must be a shared public/private cooperative effort, and a system which will allow individuals/employers to purchase additional services or insurance.

• Cost management by all stakeholders, consistent with achieving quality health care, is critical to attaining a workable, affordable, and sustainable health care system.

• Less complicated administrative systems are essential to reduce costs, create a more efficient health care system, and maximize funding for health care services.

• Sufficient funds must be available for research (basic, clinical, translational, and health services), medical education, and comprehensive health information technology infrastructure and implementation.

• Sufficient funds must be available for public health and other essential medical services to include, but not be limited to, preventive services, trauma care, and mental health services.

• Comprehensive medical liability reform is essential to ensure access to quality health care.

REDUCING THE RANKS OF THE UNINSURED

The Academy also has taken part in the Health Coverage Coalition for the Uninsured, or HCCU, which is proposing a mix of public programs and tax credits to extend health care coverage to America’s nearly 47 million residents without health insurance. The HCCU estimates that their proposal, if fully implemented, would cover more than one half of the uninsured population.

In addition to the Academy, which is the only medical specialty association in the group, HCCU members include the AMA, Families USA, America’s Health Insurance Plans, American Hospital Association, US Chamber of Commerce and United Health Foundation, as well as 9 other organizations. Coalition members have been meeting for more than 2 years to hammer out the consensus plan.

Reed Tuckson, MD, senior vice president of the United Health Foundation, moderated a news conference held in Washington, DC, at Union Station on January 18 to announce the plan. “Today, 16 powerful, influential, politically diverse and highly principled organizations, many of whom often do not come together on issues here in Washington, are gathered on this stage to announce a set of consensus recommendations—and to pledge our full and continuing support for the implementation of those recommendations,” Tuckson told reporters.

The HCCU’s proposal first focuses on expanding coverage to the nation’s 9 million uninsured children. Under the proposal, states would be given the flexibility to deem uninsured children from low-income families eligible for and enroll them in Medicaid or the State Children’s Health Insurance Program, or SCHIP, when they qualify for other means-tested programs such as food stamps.

“Surveys have shown over and over that Americans want children covered because they see the health and well-being of children as being the health and well-being of our future,” AAFP President Kellerman told reporters.

Speaking as a physician, Kellerman said getting kids insured “gives us an opportunity to discover developmental delays earlier, find medical problems when we can intervene and treat, take care of acute problems before they can become complications, and provide immunizations. So this proposal is not only cost-effective but also good medical care.”

The HCCU proposal also calls for a tax credit to help families with more income pay for private health insurance for their children. Families earning as much as 3 times the federal poverty level would be eligible. The credit would cover a significant percentage of the premium, with the percentage graduated on a sliding scale based on family income.

In addition, the proposal’s first phase would establish a grant program to enable states to experiment with innovative approaches to expand coverage.

The HCCU proposal’s second phase focuses on uninsured adults. It would give states the flexibility and funds to expand Medicaid eligibility to cover all adults with incomes below the federal poverty level. Those with incomes between 1 and 3 times the federal poverty level would get a tax credit to help them pay for private insurance.

Too often, uninsured people don’t get the primary and preventive care they need; instead, they “depend on the local emergency department as their family doctor,” said Kevin Lofton, chair of the American Hospital Association Board of Trustees. “Delaying action on the uninsured will only increase the human suffering, the moral urgency, and the financial costs to our society and to our health system. According to the Institute of Medicine, an estimated 18,000 people die each year because they do not have health insurance.”