Congress should cast final votes to get comprehensive health care reform enacted into law, ACP

Enactment is 'imperative' even though proposal 'falls short' in some respects

The American College of Physicians, representing 129,000 internal medicine physician and medical student members, said today that Congress should cast the final votes needed to get comprehensive health care reform enacted into law. Without reform, ACP said, tens of millions of Americans stand to lose access to affordable health care and out-of-control spending will trigger an unprecedented fiscal and budgetary crisis.

ACP said that H.R. 3590, the Patient Protection and Affordable Care Act, which will serve as the basis for a final bill, has essential policies to expand coverage to almost all legal U.S. residents, increase funding for programs to train more primary care physicians, increase Medicare payments for office and other outpatient visits by general internists and other primary care physicians, and accelerate pilot-testing of innovative payment and delivery system reforms to improve outcomes and reduce unnecessary cost. A related "corrections" bill will increase the subsidies to help people buy coverage, provide equitable funding to all states to offset most of the cost of expanding Medicaid to the poor- and near-poor, and increase Medicaid payments for evaluation and management services by primary care physicians, among other changes supported by ACP.

"The Senate bill, with the improvements to be voted on by Congress, will advance long-standing ACP policies to provide all Americans with access to affordable health insurance coverage," said ACP President Joseph W. Stubbs, MD, FACP. "It fills gaps in our current system by providing families and small businesses with competitive and portable private sector options to buy affordable coverage, providing subsidies when they need help, and ending egregious insurance company practices that deny patients with pre-existing conditions access to affordable coverage. ACP has long advocated for such reforms, and we are pleased that they will be in the final bill."

Dr. Stubbs noted that the bill also includes some "important first steps to begin to reverse a catastrophic shortage of primary care physicians," but that it "falls short in this and other important respects."

He added, "We will continue to urge Congress to make improvements through subsequent legislation to ensure that all primary care physicians can qualify for Medicare payment bonuses, some of whom may be excluded under the current language" [in the Senate bill]. Dr. Stubbs noted, "Medicare and Medicaid payments need to be permanently increased to ensure access, not just to primary care but for other services provided by internists. Congress must also permanently end the cycle of Medicare physician payment (SGR) cuts."

ACP also believes that Congress should have the final say, by a simple majority vote, on accepting or rejecting cost-cutting recommendations from an unelected Medicare payment advisory board to be created by the legislation.

"Is the current legislation perfect? Does it meet all of ACP's objectives? Of course not", said Dr. Stubbs. "But it will expand coverage, improve reimbursement for primary care, help train more general internists and other primary care physicians, and begin to institute other essential reforms to make health care more accessible and affordable for many millions of people. It deserves a 'yes' vote on that basis. But even after it becomes law, the work of improving our health care system will continue."

As has been the case throughout the long debate on health reform, ACP's support for the final votes to allow reform to become law is based on policy, not politics. "We didn't determine the process chosen by the majority party to move the legislation to a final vote, nor the actions of the minority party in trying to stop it from becoming law," continued Dr. Stubbs. "Like most Americans, we would have preferred that health care reform be done on a bipartisan basis with broad support, but the political environment regrettably has not allowed this to happen. Our support for getting the legislation over the finish line is based solely on how consistent it is with key ACP policies, not on the process or the politics involved."

Finally, Dr. Stubbs pointed out the consequences if the current legislation fails:

• Without any changes in federal law, spending on health care will rise to 25% of GDP in 2025 and close to 50% in 2082. The Congressional Budget Office reports that spending on Medicare and Medicaid will create an unprecedented fiscal and budgetary crisis.
• If premiums for employer-sponsored insurance grow in each state at the projected national rate of increase, then the average premium for family coverage would rise from $12,298 (the 2008 average) to $23,842 by 2020-a 94 percent increase-putting it out of reach for millions.
• By 2020, the Census Bureau projects that the number of uninsured will climb from 46 million to 60 million-one out of every five people.

"The struggles of so many of my patients who do not have jobs or whose jobs no longer provide health care benefits cannot wait. Unnecessary amputations, other unnecessary avoidable complications of diseases, and unnecessary deaths are tragically occurring every day because of lack of affordable health insurance," Dr. Stubbs concluded. "This growing American calamity needs to be fixed urgently."

Source: American College of Physicians