COMMENTARY

AAFP President: Time for our US Leaders to Listen to Us

John Meigs, Jr, MD, FAAFP

Disclosures

August 02, 2017

Editorial Collaboration

Medscape &

Editor's note: Dr Meigs's commentary was recorded at the American Academy of Family Physicians (AAFP) National Conference of Family Medicine Residents and Students on the morning after the dramatic late-night Senate vote defeating the so-called "skinny repeal" of the Affordable Care Act (ACA). The full text of AAFP's response to Congress following the vote is available online.

Hello. I'm John Meigs. I'm the current president of the American Academy of Family Physicians (AAFP) and a practicing family physician from Centreville, Alabama. I'm here today to talk to you about the recent healthcare reform legislation that has been going through the House and Senate. The latest proposal from the Senate failed last week, and that is actually a good thing. That proposal had some components that we did not think would be good for our patients.

Too many people would have lost insurance coverage—tens of millions. The proposal would also have destabilized the health insurance marketplace. Removing the individual and employer mandates would have increased premiums and have made things over time so unaffordable that no one would have been able to afford their insurance. The CBO estimated that insurance premiums would increase 20% year over year above the increases expected with current law.

But that is not to say that the current law is perfect. It is not. We still have 29 million people in this country who are uninsured. Healthcare in this country is too expensive. Deductibles are too high. Premiums are too high. We need to make substantial improvements. We need to improve and build on current law, not pull the rug out from under it. We need to modify, improve, amend—whatever term you want to use—but there are certain things that need to be done to improve health insurance coverage in this country.

AAFP recently sent a letter to the leadership of the House and Senate, offering our suggestions for the way forward. We truly believe that meaningful reform is going to take bipartisan effort. Any effort that is mostly from one side of the aisle or the other will not create the stability that is needed. We need a bipartisan effort that both parties buy into in order to have meaningful reform that will make a difference for our patients and this country.

We must make healthcare coverage more affordable and more accessible. We need a public option that will allow people ages 55-64 years to buy into Medicare or obtain a Medicare advantage plan. We need to require all insurance plans to cover the essential health benefits so that they are available to all.

We certainly need to increase competition in the health insurance marketplace. With increased competition, prices should come down and you'll see more people able to afford coverage. And we certainly need to keep all of the consumer protections in current law in place in any plan moving forward.

In order to prioritize and promote primary care, we need to have a primary care benefit. People with insurance should have their primary care, preventive services, health and wellness, and care management services included in insurance without copays or deductibles.

In order to prioritize and promote primary care, we need to have a primary care benefit. People with insurance should have their primary care, preventive services, health and wellness, and care management services included in insurance without copays or deductibles—especially in plans with high deductibles. This should be a required part of high-deductible plans.

We must stabilize the insurance market. We need to make the cost-sharing reduction subsidies permanent and fully funded so that people can have access to coverage. There needs to be a standard open enrollment period. Special enrollment periods need to be limited to a defined set of circumstances.

We know that the two most important things to increase the health of the population over time are a usual source of care and healthcare coverage—not access, but coverage. Those two features—a usual source of care that is primary care, most often a family physician; and healthcare coverage for all—have been proven to increase the health of the population. Healthcare coverage for all has been the policy of AAFP since 1989.

There are a few other things that we also suggested, including a repeal of the tax on medical devices and a repeal of the health insurance tax in [the market that serves most small-business employers and those who purchase policies individually].

We hope that our political leaders in the House and Senate will listen to us. Now is the time to go for bipartisan, meaningful reform that makes a difference for patients and the people of this country. Thank you.

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