WASHINGTON — The American Academy of Family Physicians, along with a coalition of organizations, is seeking an immediate expansion of the State Children's Health Insurance Program.
SCHIP is up for reauthorization this year.
The Health Coverage Coalition for the Uninsured, of which AAFP is a part, comprises 16 organizations that have historically parted ways on health insurance, including AARP, American Hospital Association, American Medical Association, American Public Health Association, America's Health Insurance Plans, Blue Cross and Blue Shield Association, Catholic Health Association, Families USA, Federation of American Hospitals, Healthcare Leadership Council, Johnson & Johnson, Kaiser Permanente, Pfizer, United Health Foundation, and the U.S. Chamber of Commerce.
Under the coalition's SCHIP proposal, parents would be urged to enroll children at the same time as they applied for food stamps and other programs, making it a “one-stop shop.” The federal government should also provide more funds—an estimated $45 billion over the next 5 years—to cover all eligible children, and offer tax credits to families earning up to three times the federal poverty level, according to the coalition.
“This proposal is not only cost effective, but it's good medical care,” AAFP President Rick Kellerman said at a press conference unveiling the plan.
As many as 98% of uninsured children could be covered if these proposals are implemented, estimated Families USA Executive Director Ron Pollack in a briefing with reporters.
About 47 million Americans, including 8–9 million children, are uninsured. The coalition has proposed expanding Medicaid to cover all adults with incomes below the poverty level, and offering tax credits for those with incomes between 100% and 300% of the poverty level.
Dr. Kellerman, who is also chairman of the department of family and community medicine at the University of Kansas, Wichita, emphasized that “The AAFP has long been an advocate for expanding health care coverage…. The [coalition's] proposal is realistic and achievable. America's family doctors urge Congress to vote to implement the important health coverage changes we are proposing today,” he said in a statement.
“This new Congress has a wonderful opportunity to do something real for our children,” Children's Defense Fund (CDF) founder and president Marian Wright Edelman said in a statement. The CDF had proposed its own plan in early January to expand coverage. Under that plan, all children who receive food stamps or school lunch assistance would automatically be enrolled in SCHIP. All children whose family incomes are below 300% of the poverty level would be eligible. Families with incomes over 300% could buy into the program.
In his State of the Union address, President Bush proposed tax breaks to help cover the uninsured. Families with health insurance would not pay taxes on the first $15,000 in earnings, and insured individuals would get a pass on the first $7,500. People without insurance would receive tax deductions of the same amounts. Employer-provided health benefits would be considered taxable income, but the White House estimates that 80% of Americans with those policies will still have lower taxes. He also called for federal aid to be given to states that are seeking to cover the uninsured, for expansion of health savings accounts, allowing health insurance to be purchased across state lines, and medical liability reform.
Congress has already started to move. Sen. George Voinovich (R-Ohio) and Sen. Jeff Bingaman (D-N.M.) introduced a bill to provide states with grants to creatively cover the uninsured. Companion legislation was introduced in the House. Sen. Ron Wyden (D-Ore.) introduced a bill seeking to guarantee coverage for all Americans.
More congressional action is expected, which heartens physicians and others.
“We need more action and less debate,” said Dr. Reed Tuckson, senior vice president of the United Health Foundation, speaking at the Health Coverage Coalition briefing.
“If there's any time in the recent history of this country to get this done, this is the moment,” said Dr. Tuckson, adding that “the cost of not doing anything is even more dramatic.”
On another front, the American College of Physicians has set its sights on spurring the new Congress to make Medicare implement the medical home concept.
The ACP also is proposing to replace the sustainable growth rate (SGR) formula that governs how much Medicare pays physicians and to expand coverage for the uninsured.
An “advanced medical home”—in which physicians would receive reimbursement for coordinating care in a way that addresses each patient's individual needs—is the best way to save money and improve patient care, ACP president Dr. Lynne Kirk said at a briefing with reporters last month.
“Payment systems used by Medicare, Medicaid, and most private payers reward physicians for the volume of procedures generated and number of office visits performed, rather than for ongoing, continuous, and longitudinal management of the patient's whole health, supported by systems-based practice improvements that lead to better results,” Dr. Kirk said.