Health Care Alliance Announces Proposal to Cover Uninsured

An alliance of 16 national health care organizations on January 18 announced a proposal for extending health care coverage to those who are uninsured. The Health Coverage Coalition for the Uninsured, which includes the American Academy of Family Physicians (AAFP), the American Medical Association, and the Catholic Health Association, advocates a mixture of public programs and tax credits to achieve coverage. Two phases are outlined—the first focusing on children and the second on adults. In phase 1, states would be given the flexibility to determine children as eligible for Medicaid or the State Children's Health Insurance Program (SCHIP) when they qualify for other means-tested programs, and then enrolling them. A tax credit would be established to help families with higher incomes pay for private health insurance for their children. The credit would cover a percentage of the premium on an income-based sliding scale, with eligibility for families earning up to three times the federal poverty level. In addition, a grant program would enable states to experiment with new approaches for expanding coverage. In phase 2, states would be given the option of expanding Medicaid eligibility to all adults with incomes below the federal poverty level and would be provided with federal funds to do so. Those with incomes between one and three times the federal poverty level would get a tax credit to help them pay for private insurance. For more information and to access the full proposal, go to http://www.coalitionfortheuninsured.org/historicagreement/historicagreement.html or https://www.aafp.org/news-now/health-care-reform/20070123hccu.html.

Health Coverage, Physician Payment Are Priorities for AAFP Chapters

According to results of a 2007 survey of AAFP chapters, the top legislative priorities for this session are increasing health care coverage, raising physician payment, safeguarding or expanding the scope of practice, and promoting public health initiatives. The most commonly cited issues of interest in the survey included access to care (e.g., comprehensive health system reform, expanding Medicaid or SCHIPs), managed care and physician payment (e.g., fair contracting, downcoding and bundling of claims, prompt payment, assignment of benefits), scope of practice (e.g., pharmacist collaborative practice, prescriptive authority for nonphysicians, expansion of chiropractic and lay midwifery, naturopathic licensure), and public health (e.g., tobacco-use cessation and smoke-free environments, vaccine distribution, obesity, emergency preparation). For more information, go to https://www.aafp.org/news-now/government-medicine/20070117chapterpriorities.html.

Supreme Court Refuses to Hear NRMP Antitrust Lawsuit

The U.S. Supreme Court declined to hear a final petition filed by the plaintiffs in an antitrust lawsuit concerning the National Resident Matching Program (NRMP), ending litigation first filed in May 2002. In the suit, three former resident physicians claimed that the Association of American Medical Colleges and more than 30 other associations and academic health centers violated antitrust laws by conspiring to “illegally restrain competition in the market for resident physician services” through the NRMP. The U.S. District Court for the District of Columbia dismissed the lawsuit in 2004 and 2005, ruling that Title 15 of the Pension Funding Equity Act of 2004, which exempts the NRMP from antitrust violations, rendered the issue moot. The U.S. Court of Appeals affirmed the dismissal in June 2006 and the plaintiffs subsequently petitioned the Supreme Court. For more information, go to http://www.aamc.org/newsroom/jungcomplaint/start.htm or https://www.aafp.org/news-now/resident-student-focus/20070116nrmplawsuit.html.

MedPAC Recommends Updating Hospital Base Payment Rates

At its meeting on January 9–10, the Medicare Payment Advisory Commission (MedPAC) recommended that Congress update hospital inpatient and outpatient base payment rates and reduce indirect medical education (IME) payments by 1 percentage point to 4.5 percent in 2008. The funds obtained from reducing the adjustment should then be used to finance a quality incentive payment system, the Commission said. According to AAFP Director of Medical Education Perry Pugno, M.D., M.P.H., the recommendation could enhance or prove disastrous to teaching hospitals' financial well-being, depending on its implementation. A hospital update would increase diagnosis-related group (DRG) payments for patients with higher acuity, which could increase a hospital's Medicare income and offset a reduction in IME payments. However, Pugno cautioned that the reduction in payments should not go into effect before a compensation system for the care of patients with complex needs is in place. In addition, without offsetting federal support for medical education, such as IME funds, training programs seen as less productive than others could become vulnerable, medical educators said. Athough residency programs earn patient-care income, primary care residency programs often are seen as more costly. For more information, visit http://www.aamc.org/advocacy/teach-hosp/medpac/start.htm or https://www.aafp.org/news-now/resident-student-focus/20070123medpac.html.

State Initiatives Lead Efforts for Health Care Reform

According to a National Conference of State Legislatures analysis, issues such as the increasing number of uninsured Americans, the declining number of employers offering health insurance, improved fiscal conditions in states, and the lack of federal action are causing states to take steps toward health care reform. More than 10,000 health-related bills have been introduced in state legislatures across the country this session. Seven states will hear from commissions charged with making recommendations on expanding coverage and reforming health care; at least 19 governors have called for health system reform in their state-of-the-state addresses, and seven legislatures have responded with bills proposing universal access, tax benefits for small businesses, expansion of Medicaid and SCHIP funds, or expansion of eligibility for SCHIPs. In California, Assembly Bill 53 proposes enacting legislation that would provide universal health coverage regardless of age, income, employment, or health status. In New Hampshire, House Bill 88 would establish a committee to study a single-payer system; and in Minnesota, Senate Bill 14 would establish a universal health system that provides affordable access to medical care for all residents. For more information, go to http://www.ncsl.org/programs/health/universalhealth2006.htm or https://www.aafp.org/news-now/government-medicine/20070124stateshealthreform.html.

STFM Launches “Future Family Docs” Youth Mentoring Campaign

The Society of Teachers of Family Medicine (STFM) has launched a new campaign to recruit young people into family medicine. The campaign, “Future Family Docs,” will focus mentoring efforts on premedical school recruitment, particularly among students from underrepresented minorities and rural communities, according to a statement by STFM President Caryl Heaton, D.O., in the January issue of Family Medicine. STFM's goal is to increase the number of middle school and high school students who consider—and begin planning for—a career in family medicine. Resources for the program include a new Web site (http://www.futurefamilydocs.org) and a workbook published by the AAFP for use in high school classrooms. For more information, visit https://www.aafp.org/news-now/resident-student-focus/20070116youthmentoring.html.

CIGNA Increases Physician Reimbursement for Vaccines

CIGNA HealthCare has announced an increase in its national reimbursement fee schedule for vaccines. The new rates exceed acquisition prices from vaccine manufacturers and became effective January 15. The rates apply to all physicians who adhere to CIGNA's national fee schedule and who stock and administer preventive vaccines in their offices. In addition, a review of CIGNA's national reimbursement rates for administering vaccine is currently under way, with a decision expected later in 2007. The American Academy of Pediatrics led an effort to increase vaccine reimbursement, arguing that physicians have costs involved in the purchasing and storage of vaccines above those of acquiring them from the manufacturer. The AAFP has requested that CIGNA pay physicians for both preventive and evaluation and management services when they are delivered to a patient during the same office visit. For more information, visit http://www.cignaforhcp.com or https://www.aafp.org/news-now/practice-management/20070124cigna.html.

NHLBI Launches COPD Campaign Aimed at Patients, Physicians

The National Heart, Lung and Blood Institute (NHLBI) is partnering with several other organizations (including the AAFP) to introduce the “Learn More Breathe Better” campaign designed to improve awareness among patients at the greatest risk of chronic obstructive pulmonary disease (COPD). According to the NHLBI, COPD is the fourth leading cause of death in the United States, and the number of cases is increasing. The campaign is targeted at three audiences: men and women who are at risk; patients diagnosed with COPD; and health care professionals, especially those in primary care. By outlining the symptoms of the disease, the campaign partners hope to prompt patients to recognize those symptoms in themselves and to seek help. For more information, visit http://www.nhlbi.nih.gov/health/public/lung/copd/lmbb-campaign/index.htm or https://www.aafp.org/news-now/health-of-the-public/20070124copdcampaign.html.

— AFP and AAFP NEWS NOW staff