Academy Joins Call for Bold Health Policy Improvements

Front-line Physicians Offer Detailed Health Care Counsel to White House

February 23, 2021, 12:40 pm News Staff — In a Feb. 17 letter to President Joe Biden, the AAFP and its fellow front-line physician organizations delivered comprehensive recommendations advocating for robust vaccination efforts and improved health care coverage and availability during and beyond the COVID-19 pandemic.

The Group of Six coalition — which also includes the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association — called on the White House to focus on six high-priority issues.

COVID-19 Vaccination

Citing a January 2021 Primary Care Collaborative survey indicating that 89% of primary care clinicians intend to get vaccinated, the groups wrote, “It is essential that steps be taken immediately to ensure that primary care and other community-based physicians are prioritized and able to get vaccinated.”

The groups also called for community-based practices to be included in vaccine distribution plans, noting that 71% of medical practices last month reported they were unable to obtain COVID-19 vaccine for their patients. Continuity of care should in turn be maintained with policy ensuring that all vaccinators, including retail clinics and pharmacies, communicate with a patient’s primary care team.

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Health Care Coverage and Access

To build and improve on the Patient Protection and Affordable Care Act, the groups urged that the administration follow its recent health care-related executive orders by

halting and reversing the Short-Term, Limited Duration Insurance final rule, which allows insurers to discriminate against patients with pre-existing conditions, among other harms;
expanding the 45-day ACA annual enrollment period to at least 90 days;
expanding funding and support for ACA outreach and navigators;
lowering the cap on eligibility for premium subsidies — currently set at 400% of the federal poverty level — while reducing cost-sharing under ACA marketplace plans and expanding competition and supporting health insurance exchanges’ ability to offer a public insurance option that reimburses physicians at rates no less than those of traditional Medicare; and
reversing the public charge rule.

Medicaid

Noting that Medicaid affords essential health care coverage to more than 75 million Americans, the groups urged action beyond the recent executive order requiring agencies to identify unnecessary barriers to Medicaid or ACA coverage. The letter recommended that the White House, working with Congress,

increase Medicaid’s federal medical assistance percentage during the public health emergency and at least through the end of 2021 (as the Academy and more than 100 state and national health care and public policy groups called for last July);
withdraw the 1115 Community Engagement Initiative guidance and the Healthy Adult Opportunity guidance, and rescind approval for work-requirement and other waivers that reduce coverage;
approve pending waivers that broadly expand coverage, including those that allow payment for behavioral health treatment and extend postpartum Medicaid coverage beyond 60 days;
create incentives for remaining states to expand Medicaid; and
enact legislation to align Medicaid payments for primary care services with Medicare payment levels.

Women’s Health

“Immediate action is needed to address critical women’s health issues; reverse harmful women’s health policies; and advance policies that protect, enhance and promote the health of women and families across the country,” the letter said, noting that such steps remain important in safeguarding the physician-patient relationship. The groups advocated for

approval of Section 1115 waivers extending Medicaid coverage for pregnant individuals beyond 60 days postpartum — which “could mean the difference between life and death for many women;”
rescinding the Compliance with Statutory Program Integrity Requirements rule and any other regulations governing the Title X program that impose undue restrictions on women’s access to complete medical information; and
rescinding the Religious Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act and the Moral Exemptions and Accommodations for Coverage of Certain Preventive Services Under the Affordable Care Act regulations, which undermine the ACA by undercutting access to contraception without cost-sharing.

Workforce

“Our nation is facing a significant shortage of primary care and mental health physicians,” the groups warned. To reinforce and diversify the health care workforce, the letter called on the administration, working with Congress, to

reverse a Department of Labor rule that exacerbates physician shortages and disrupts access to care by increasing the minimum required salary that hospitals and clinics must pay physicians with H-1B visas (as the Group of Six called for last fall); and
enact legislation to provide permanent relief for high medical student debt, beyond temporary relief during the PHE.

Administrative Complexity

“It is critically important to put patient care first by reducing unnecessary administrative burden,” the groups wrote. Among the five actions the letter urged under this heading were calls to streamline or eliminate prior authorization and to reissue requests for information for a December 2020 CMS proposed rule that spanned a broad range of related policy proposals but was closed to public comment after less than 30 days.