Early signals from the Obama administration have many physicians feeling optimistic about the chances for comprehensive health reform.
Officials at the American Academy of Pediatrics have been in contact with congressional staff members to make their priorities known, starting with the reauthorization of the State Children's Health Insurance Program.
Although many Democrats in Congress have supported the reauthorization of SCHIP in the past, there are still questions about whether this will be pursued as a stand-alone bill or as part of the new administration's economic stimulus package.
Another piece of the SCHIP reauthorization that has yet to be resolved is whether the bill will include immediate coverage for immigrant children, an issue that created controversy in the past.
AAP officials also are hopeful that Congress will use the Medikids Health Insurance Act legislation, which has stalled in previous sessions of Congress, as the children's portion of the larger health reform plan. The legislation would create Medikids, a health insurance program modeled after Medicare, that would act as a safety net to ensure coverage for all children. Under the legislation, children would be automatically enrolled in Medikids but transferred to other insurance or government programs if they are eligible. Children could regain coverage under Medikids at any time if they lose their other coverage for any reason.
The AAP also would like to see Congress continue to encourage investment in the concept of the medical home by expanding demonstration beyond the Medicare program into the Medicaid program, where pediatricians can get involved.
The AAP and other physician groups have a greater chance of getting some of their priorities addressed this time around because of the poor economic conditions, said Dr. Nancy H. Nielsen, president of the American Medical Association. As more Americans lose their jobs, they are also losing their health insurance, she said, driving policy makers to address the issue of the uninsured. “There may be more tension for change now than there has been in the past,” she said.
President Barack Obama addressed that tension head-on during a press conference last month to announce former Sen. Tom Daschle (D-S.D.) as his choice for Health and Human Services secretary. The current state of health care in the United States—with rising premiums and the large number of uninsured Americans—is having a direct and negative impact on the U.S. economy, President Obama said. “If we want to overcome our economic challenges, we must also finally address our health care challenge.”
In a move that many agree signals how serious President Obama is about health reform, he tapped Sen. Daschle not only to serve as HHS secretary, but also to direct a new White House Office on Health Care Reform.
Jeanne M. Lambrew, Ph.D., a health policy expert who coauthored the health care book “Critical: What We Can Do About the Health-Care Crisis” with Sen. Daschle, was chosen as deputy director of the new White House office.
In another example of his focus on health care reform, Mr. Obama, along with congressional Democrats, have signaled their interest in including health information technology incentives as part of an economic stimulus package, said Robert Doherty, senior vice president of Governmental Affairs and Public Policy at the American College of Physicians. “I think the signals are positive.”
Physician societies are making their priorities known to the new administration, emphasizing the need for physician payment reform to be a part of any reform package.
ACP officials are hoping that the Obama health care reform proposal will include some of their top priorities—coverage of the uninsured and improving access to primary care physicians. The experience with the Massachusetts health care reform law illustrates that expanding insurance coverage does not guarantee access to care if there are not enough primary care physicians to see all the new patients, Mr. Doherty said.
Shoring up the primary care workforce will require an increase in payments for primary care services, an emphasis on primary care in graduate medical education funding, and the creation of programs that would allow primary care physicians to eliminate their medical school debt, he said.
Officials at the American Academy of Family Physicians also are calling for increasing payments for primary care services, addressing the shortage of primary care physicians, and advancing the primary care model known as the patient-centered medical home.
Dr. Ted Epperly, AAFP president, said he is confident that the medical home concept will be part of the health reform proposal that will be considered by Congress. All of the major players in the new administration and in Congress have mentioned the medical home and primary care reform as part of the solution, he said. “The concepts are known to them.”