Why would family physicians support the bills in Congress?
The legislation in the House of Representatives contains numerous provisions that are designed to support primary care physicians. There is a bonus payment to primary care physicians of 5 percent (10 percent if the practice is in a physician shortage area – usually rural areas). The SGR is eliminated (which is good for all physician practices) and the replacement system has higher conversion factors for E/M and preventive care services, which are the ones that most family physicians provide. Primary care services in Medicaid are paid at least at the Medicare rate, which is a substantial increase in some states. The legislation invests in a broader pilot-testing of the medical home practice model. And payments to departments of family medicine and to family medicine residencies are increased, and there is increased tuition assistance for medical students who choose family medicine (or other primary care specialties). The legislation is the first major investment in primary care that the federal government has made in years. Finally, the bill is consistent with our long-term policy of supporting health care coverage for all – and this legislation is a step in that direction.
Many of my elderly patients are concerned that Medicare is going away. What should I tell them?
There is nothing in the current bills that would take away Medicare. Please tell your patients that Medicare will still be there for them – even if health care legislation passes Congress. The legislation does not eliminate the program, nor does it eliminate benefits.
Why is the AAFP supporting a so-called “public plan?” I think that will lead to a single-payer system or socialized medicine.
The legislation preserves the private insurance market, so medicine will not be socialized. But what it is intended to do is to provide some competition for insurance companies, especially in areas where one company is dominant or a monopoly, which are often rural and where many of our members have no leverage in negotiating with the major plans. Members have been asking for years to find some method to give them some bargaining power with the major plans. While this is not the best mechanism, it is a start. In addition, it is not at all clear whether or not a public plan will be part of any final bill. Many Members of Congress – particularly in the Senate – are discussing the idea of a “co-op,” which would be a non-profit entity run by the members at the state or national level. However, the AAFP Board of Directors discussed public plans at length, since this option has been part of the discussion for quite some time. The Board came up with principles on a public plan option, consistent with those set forth in the New America Foundation document “A Modest Proposal for a Competing Public Health Plan” (12-page PDF file; About PDFs). These principles are:
- administrators of the public plan must be accountable to an entity other than the one identified to govern the marketplace -- in other words, the authority overseeing the marketplace and responsible for enforcing its rules should not have an incentive to favor a public plan compared with private plans;
- the public plan cannot be Medicare;
- the public plan must be actuarially sound;
- the public plan cannot leverage Medicare or any other public program to force providers to participate;
- the public plan should not be required to use Medicare payment rates;
- insurance market rules and regulations governing the public plan must be the same as those governing private plans;
- the public plan cannot be granted an unfair advantage in enrolling the uninsured or low-income individuals, who presumably will be eligible for subsidies in the new marketplace;
- public and private insurers should be required to adhere to the same rules regarding reserve funds; and
- the public plan would need to contribute to value-based initiatives that benefit all payers.
- Protects patient choice
- Prohibits pre-existing condition exclusions
- Requires guaranteed issue and renewal for insured plans
- Requires parity in mental health and substance abuse disorder benefits consistent with AAFP policy
- Ensures adequacy of provider networks.
- Ensures value and lower premiums
- Requires coverage of essential benefits package including prevention
- Requires fair marketing practices by health insurers
- Requires fair grievance and appeals mechanisms
- Requires information transparency and plan disclosure
- Requires timely payment of claims c
- Requires administrative simplification
- Closes the Medicare Part D donut hole is also big for our patients.
- Eliminates annual and lifetime caps on losses.