President's Health Insurance Plan Has Pros, Cons for Family Physicians

President Bush's plan to expand access to health insurance through tax deductions may be a step in the right direction, but it falls short of the comprehensive health system reform supported by the American Academy of Family Physicians (AAFP), according to AAFP President Rick Kellerman, M.D., of Wichita, Kan. In response to President Bush's January 23 State of the Union address, Kellerman praised the President's statement that patients and their physicians make the best health care decisions. He also recognized the importance of President Bush's plan to expand health care coverage for U.S. citizens, particularly children, by reauthorizing the States Children's Health Insurance Programs (SCHIPs). However, parts of his proposal may pose problems for access to care and medical education, AAFP leaders said. The plan calls for changing the U.S. tax code to treat employer-sponsored health benefits as taxable income but to allow an annual health care deduction, and to fund state initiatives for providing basic health insurance by diverting capital funds and Medicare/Medicaid disproportionate share funds from hospitals and other health care facilities. The plan does not necessarily encourage access to medical homes, and it uses funds that now go to help teaching hospitals, which provide primary care education, the AAFP said. According to AAFP leaders, without addressing the issue of rewarding expensive procedures and underpaying primary care physicians, the United States will continue to have a shortage of primary care physicians, and all families will have limited access to affordable and high-quality care. For more information, visit https://www.aafp.org/news-now/government-medicine/20070124stateofunion.html.

AAFP Opposes President's Proposed Budget Cuts to Health Care Programs

The AAFP is calling on Congress to reject portions of the 2008 federal budget proposed by President Bush that could reduce access to health care. The proposed budget calls for reducing Medicare by $76 billion; cutting Medicaid by $26 billion; continuing use of the current formula for Medicare physician payment; and dropping all funding for Title VII primary care education programs. The budget breaks promises to ensure access to care for seniors, uninsured children, and low-income families, Kellerman said, and it offers no creative solution to an unsustainable physician payment formula. The federal budget serves as a guide for how Congress will appropriate money in legislation that funds government agencies and programs. The proposals have received a cool reception from Congress, and Congressional observers expect significant changes to Medicare, Medicaid, and Title VII budget measures. For more information, visit https://www.aafp.org/news-now/government-medicine/20070209bushbudget.html.

Retail Health Clinics Sign Agreement to Support AAFP's Desired Attributes

Three retail health clinics prominent in the national health care market have signed an agreement in support of the AAFP's list of desired attributes for such clinics. In the agreement, RediClinic, MinuteClinic, and Take Care Health Systems consented to limit the scope of clinical services provided, operate under the supervision of a practicing licensed physician, foster continuity of care between patients and their primary care physicians, and refer patients to physicians when symptoms indicate a condition that goes beyond the clinic's agreed-upon scope of practice. Either party can terminate the agreement at any time without cause by giving no less than 30 days' notice. The AAFP said it would not police these clinics and does not endorse them. However, by determining common ground and opening up communication channels, the AAFP hopes to ensure patient safety in the clinics and get a measure of input into how these clinics are operated. For more information, visit https://www.aafp.org/news-now/professional-issues/20070201retailhealth.html.

U.S. Lawmakers, Coalitions Call for Title VII Support

Several health professions education advocates, including the AAFP, launched a campaign to boost fiscal year 2007 funding for Title VII of the Public Health Service Act over fiscal year 2006 levels. Coalition for Health Funding members sent letters to leaders and appropriations committee chairs in the U.S. House and Senate stating that public health programs funded by Title VII are the nation's primary investment in heath education, access to services, and research. In addition, the Health Professions and Nursing Education Coalition (which includes the AAFP and 58 other health organizations) wrote to Rep. David Obey, D-Wis., chair of the House Appropriations Committee, to encourage restoration of $155 million to Title VII for health professions education. Four House members echoed coalition calls for restoring Title VII funding to 2005 levels ($300 million) in a January 22 letter to Obey, and 45 members of Congress signed a January 16 letter urging President Bush to provide $172 million to Title VII health professions training programs in his 2008 budget proposal. For more information, visit https://www.aafp.org/news-now/government-medicine/20070201supporttitlevii.html.

Study Questions Content of Direct-to-Consumer Drug Advertisements

A study in the January/February issue of Annals of Family Medicine concluded that direct-to-consumer advertisements by pharmaceutical companies have limited educational value and may oversell the benefits of drugs. The authors of “Creating Demand for Prescription Drugs” analyzed 38 pharmaceutical advertisements shown at peak television viewing times in 2004. Although most included some facts and rational arguments for using a product, few described the causes of the condition, its risk factors, or its prevalence, and emotional appeals were common. The authors suggest that the differences between selling consumer products and selling prescription drugs should be reconsidered. Whereas poor judgment among soap brands may have few consequences, they point out, the influence of direct-to-consumer advertising on drug preferences—and the resulting pressure on physicians to prescribe cost-ineffective or inappropriate drugs—is of significant concern for health care spending and population health. For more information, visit http://www.annfammed.org/cgi/content/full/5/1/6 or https://www.aafp.org/news-now/clinical-care-research/20070130annalsdtcads.html.

Internists' Annual Report on Nation's Health Recommends Payment Reform

The American College of Physicians (ACP) has released its annual report on the nation's health care, highlighting problems in the U.S. health care system and calling for payment reforms designed to shift the nation's focus back to patient-centered primary care and prevention. Problems outlined in the report include the number of Americans without health insurance; high per capita spending for health care; underuse of preventive care; overuse of invasive procedures; and a lack of patient-centered, coordinated care. According to the ACP, primary care medicine in the United States is on the verge of collapse. Because primary care is undervalued, new physicians are discouraged from entering the field, and practicing physicians are discouraged from staying, while the aging of the population puts an increasing demand on primary care services. The outcome will be higher costs, lower quality, diminished access, and decreased patient satisfaction, the report states. The ACP suggests that the solution is to redirect federal health care policy to support patient-centered health care that builds on a medical home where patients have consistent access to a personal physician who takes responsibility for managing their care. For more information, visit http://www.acponline.org/hpp/statehc07_1.pdf or https://www.aafp.org/news-now/professional-issues/20070202acpannualrpt.html.

AAFP Urges Repeal of Mid-Level Provider Rule for Rural Health Clinics

The AAFP has called for an end to a federal requirement that rural health clinics have a nonphysician health care provider on site for at least one half the time the clinic is open. In a letter to the Senate Finance Committee, AAFP Board Chair Larry Fields, M.D., Flatwoods, Ky., urged Congress to repeal a statutory provision in the Rural Health Clinics Act of 1977 that includes this requirement as part of the definition of a rural health clinic. The requirement limits staffing flexibility for family physicians who operate rural health clinics, Fields said. He urged Congress to change the law to allow for the employment of nonphysician practitioners or physicians, depending on who was available and could provide the highest quality of care. For more information, visit https://www.aafp.org/news-now/professional-issues/20070207ruralhealthclinics.html.

Federal Bills Would Fund State Health Reform Initiatives

A bipartisan group of federal lawmakers on January 17 announced two proposals that would provide federal funding for state initiatives to expand health care coverage to the uninsured. The identical bills—the Health Partnership Act in the Senate and the Health Partnership Act Through Creative Federalism in the House—would authorize grants to individual states, groups of states, or parts of states to develop and implement programs that would increase access to health insurance. Participating states would submit plans for expanding health care coverage to a bipartisan commission, which would send its recommendations to Congress for funding appropriations. Among state proposals that could be considered are tax credits, expansion of Medicaid and the SCHIP, development of single-payer systems, and expansion of health savings accounts. States would report their programs' progress to the commission, which then would report to Congress and recommend further action regarding overall health care system reform. For more information, visit https://www.aafp.org/news-now/government-medicine/20070126fedsonstatereforms.html.

— AFP and AAFP NEWS NOW staff

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