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Thursday Jun 28, 2012

After Court Ruling, Academy Prepared to Implement ACA, Address its Shortcomings

The Patient Protection and Affordable Care Act has been a divisive issue not only in our country but also amongst our own membership. Clearly, it is far from perfect legislation. But now that the Supreme Court finally has issued its long-awaited ruling, we can move forward with needed health system reforms.

The Academy will continue to work to implement the best pieces of the ACA, advocate for change in provisions of the law that are flawed and address the law's two key deficiencies -- meaningful medical liability reform and a replacement for the sustainable growth rate (SGR) formula.

The ACA, even with its flaws, provides a pathway to reach the AAFP's vision of health care for all, a policy goal the Academy has been pursuing for more than two decades. By extending health coverage to roughly 30 million more people, the law will improve the health of the nation by ensuring access to basic primary care, including preventive services and chronic disease management.

The court's decision helps our patients by preserving provisions of the ACA that:

  • eliminate annual and lifetime coverage limits;
  • eliminate cost sharing for preventive services;
  • prevent payers from denying coverage based on pre-existing conditions; and
  • allow young adults to stay on their parents' insurance up to age 26.

For primary care physicians, the court's decision preserved provisions of the ACA that:

  • create Medicare primary care payment incentives; and
  • boost Medicaid payments for primary care services to Medicare levels.

      For our workforce, the decision means investment in primary care education and training will continue through:

  • funding for teaching health centers;
  • scholarship and loan repayment programs in the National Health Service Corps;
  • support for the health professions grants for family medicine; and
  • establishment of the Health Care Workforce Commission.

The ruling also means that projects intended to align payment to support medical home transformation will continue. (Speaking of which, the deadline to apply for CMS' Comprehensive Primary Care Initiative is July 20. If you are in one of the initiative's seven markets, I encourage you to apply.)

There is plenty to like, and dislike, about the ACA. The bottom line is that our Academy will work to maximize the provisions of the law that benefit family physicians and our patients while also addressing issues where the law is lacking or deficient.

Glen Stream, M.D., M.B.I.is president of the AAFP.


Dr. Stream Respectfully you are missing the boat. FP physicians are the lowest paid of any doctors on average. My specialty colleagues make on average 3-5 times more than me. But yet you praise Obama Care. Let me tell you something. No one, including non-citizens of this country are denied health care. The majority of US citizens are already receiving health care free at the expense of us who continue to work and pay taxes. Most of the time these free loaders receive better care than those who work and have insurance through their employment. Many of my friends don't access care because their employers have limited or reduced their health care benefits solely because the insurers have already increased the insurance premiums to them on average 35-50 percent over the last two years in preparation for "Obama Scare". You state the ACA prohibits denying coverage due to pre-existing conditions. What you don't say is nowhere in the provision does it restrict how much the insurance companies can charge for that coverage. I am such a person. I have heart valve disease. I had mitral valve repair at the Cleveland Clinic in 2005. Even though the surgeons told me my valve is better now and will last my lifetime, I cannot get individual coverage because of it. I attempted to get it after I left my last job but my premiums were going to be $2690 per month. That's a third of my income. Don't think it won't be the same under the ACA. Presently I care for the poor, Medicaid, Medicare, drug addicted, Hepatitis C, HIV and mentally Ill patients. They all have access to health care, health care that I help pay for through my taxes but cannot afford the care I need. Now, isn't that ironic? I think you should ask the AAFP Members just how they truly feel before patting yourself on the back and praising what a wonderful thing this is. The bill, all 2700 pages has many unknowns. The majority of our government leaders don't even know themselves. Mandating individuals buy insurance they cant afford is communistic let alone morally right. The ones paying for it now will only pay more taxes, while the ones receiving free health care now keep on sucking the system dry. Why should they care? Is it fair to pass this burden on to those that are already burdened to the max now? I don't think so! Wake up and smell the roses. Please reconsider your opinion or at least refrain from further comments until you poll your members and let their opinions be heard. R. Dan Bieser DO Fellow and Diplomate

Posted by R Dan Bieser on June 28, 2012 at 10:55 PM CDT #

How to pay for all people? Is it going to be affordable? low income families will enjoy this free ride at the cost of people who are working? add more burden to people who are already working and kill them.... It looks good philosophically and at consumer level but difficult to have ends meet financially... PAY MORE TAXES.. WORK HARD. TAKE CARE OF LOW INCOME FAMILIES. TAKE HOME LESS AMOUNT OF PAYCHECK. SEE MORE NUMBER OF PATIENTS. BTW--no mention of tort reform.. REFORM-should focus on controlling costs and decreasing premiums for cosumers. Respectfully

Posted by prashant parikh,MD on June 30, 2012 at 07:11 AM CDT #

Dr Bieser, I really feel for your situation. I think you are right, sometimes the poor get better care than those who are working, and trying to provide a decent living for themselves. It is really a travesty. Another thing about ACA that I am most concerned about is the lack of a conscience clause- or its deliberate removal. We are not here to do whatever patients want, especially when it is immoral. I strongly object to the HHS mandate and the payment provisions for abortion within the ACA. I wish the AAFP would look at these things seriously. There is a physician shortage, and if we are asked to do things we consider immoral, some of us will not last in this profession.

Posted by terese shearer on July 05, 2012 at 07:17 AM CDT #

Your approach to implementing and improving the ACA makes sense to us at AAFP members. Thanks for promoting improvements in primary care, payments for preventive services and liability reform. Thomas K. Welty, MD, MPH Edith R. Welty, MD 939 Flynn Lane McCall, ID 83638

Posted by Thomas K Welty on July 05, 2012 at 07:35 AM CDT #

I've always felt Obamacare was an alternative effort after what was tried didn't work: price controls through CMS and limits on resources through certificate of need etc. Efforts to control overall costs instead helped create a crony pseudo-capitalist system that is worse than what many countries have put into place through social-democratic processes and arguably have better support of both physicians and citizenry. Obamacare to me was only the first step: to make everyone be part of a system that needs more fixing. But Obamacare itself may have consequences that will, with increased punitive measures, take away what's left of independent practice, and work against the patient-doctor relationship. See http://online.wsj.com/article/SB10001424052702304708604577505210356532588.html which describes how our role may become more as employed data-entry clerks and less as independent free-thinking complex-problem-solving professionals. I won't hold my breath to see if Obamacare can cure the wildly inefficient payment tilt toward high tech specialty care that drives moneyed entrenched self-interests today. See: http://online.wsj.com/article/SB10001424052702304830704577497024284229362.html

Posted by Peter Rives on July 05, 2012 at 07:48 AM CDT #

I too sympathize with those who feel cheated by the bill. But the answer is not to continue the status quo. If anyone is doing the cheating, its the insurance industry and Big Pharma (evidence the recent penalty against GSK). As a profession we need to stand up and say that we are tired of them running the game! What would you all who criticize the bill recommend? The system will crash with or without the bill until we put everyone on the same playing field. If you feel the poor on Medicaid get better treatment than your paying patients, then offer a better solution. I am also disturbed by the characterization of patients on Medicaid as freeloaders. That goes against fact and also is a statement counter to the philosophy of all medicines. Treat all in need, not just those with the gold. Bring all of your insured patients peace of mind and bring them up to the care that everyone gets. I challenge family docs to start advocating as a whole for real reform, Medicare for all, single payer. It's the logical, fair, fiscally responsible way. And those of you who want the government out of it, I got news for you, we can't survive, nor can medicine as we know it survive without government support. 60% of health is already funded by tax dollars. Why not get what we pay for?

Posted by John Cavacece on July 05, 2012 at 08:05 AM CDT #

John, what you say makes sense on the surface but doesn't take into account market economics. Its entirely possible that government subsidies just go into the pockets of the the wealthy entrenched self interests. What we pay currently in personal premiums, co-pays, and deductibles may cover much of the care we would pay for if we actually had to do so "out of our own pocket" and not with "someone else's money!" The equation is not a static one! What would be left of the poor can be covered with block grants etc. without the unfair and inefficient incentive's of the system we have in place.

Posted by Peter Rives on July 05, 2012 at 08:14 AM CDT #

Health insurance is not needed and should not be used for primary care services. By not having the administrative expenses involved with insurance, we can afford to charge patients less than what they pay a month for their cell phones.

Posted by Keith Dinklage M.D. on July 05, 2012 at 10:53 AM CDT #

I have a suggestion. I have been trying to look through the Pdf of the ACA, and find it too difficult for one person. It indexing is difficult to group key points in a summary.The AAFP could ask for member volunteers to review an assigned section of the act, and try to evaluate it, then report by email their findings, in ( ? ) words or less, and then publish the reduced document for all of us to understand. I stand as the first volunteer should you feel this is a good idea to try.

Posted by Robert Nicewander on July 06, 2012 at 04:56 PM CDT #

Well, well... Dr. Stream, here it comes. Just what you wanted, your socialist 'utopia'. Obama-care is a well recognized, thinly veiled, Trojan Horse for a single payer system. How are those 'reimbursements right know from Medicare and Medicaid folks? Just imagine when the government has the whole enchilada. How many insurance companies will continue to provide reasonably priced coverage when they are forced to accept those 'pre-existing conditions'? How many insurance companies will stay in the game? Who, in their right minds, will want to go into primary care? Yes, it is about the patients. It is ALSO about the folks providing the care. The single payer system does not work well anywhere my friends. But, we will go through the process, repeating the mistakes of Western Europe. Just do me a favor. Will the last physician left still doing primary care please turn off the lights? Mark Stevens, MD

Posted by Mark Stevens, MD on July 23, 2012 at 10:03 PM CDT #

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