Primary Care Groups Will Consider Public Option—with Caveats

Janice Simmons, for HealthLeaders Media , June 30, 2009

The American Medical Association has garnered most of the attention in recent weeks about its healthcare reform views--especially in regards to its chilly response toward a public plan option.

But while the AMA is the largest physician organization in the U.S., other groups representing physicians--particularly primary care physicians--have been vocal about what they would and would not like to see in healthcare reform legislation.

In the past two weeks, hearings on both the House and Senate side of healthcare reform legislation have given many of these physician groups—who represent the majority of physicians who care for Medicare patients—a chance to be heard on issues, including insurance exchanges, comparative effectiveness research, Medicare and Medicaid improvements, and public plan options.

American Academy of Family Physicians President Ted Epperly, MD, recently told two House panels, which were holding hearings onthe tri-committee draft healthcare reform bill, that his organization was "highly supportive of many of sections" of the draft measure.

In the AAFP's view, he said, "a reformed system should provide health coverage for all, promote primary care, support coordination and reduce fragmentation of care, minimize administrative complexity, prohibit denial of insurance on the basis of a preexisting condition, require an affordable basic benefit package that includes prevention and wellness, and protect against catastrophic costs."

AAFP said it would support a public plan option that is "consistent" with a list of principles including:

  • The value of primary care is acknowledged though creation of such things as patient-centered medical homes.

  • The new public plan must be actuarially sound.

  • Public and private insurers should be required to adhere to the same rules regarding reserve funds.

  • The public plan should not be required to use Medicare-like payment methods permanently.

"We are pleased that the [House] bill takes a comprehensive approach to reforming healthcare," said Joseph Stubbs, MD, president of the American College of Physicians (ACP), the second largest physician group in the country.

Stubbs said that ACP supported the overall approach to providing affordable coverage including:

  • Expanding Medicaid to cover everyone at or modestly above the federal poverty level.

  • Providing individuals and small businesses with a choice of health plans offered through an exchange.

  • Providing sliding scale subsidies for individuals to purchase coverage through such an exchange.

  • Eliminating cost-sharing requirements for preventive services.

  • Requiring that all health plans, inside and outside an insurance exchange, abide by rules relating to acceptance of all individuals--without regard to pre-existing conditions or health status--plus guaranteed renewability and modified community rating.

ACP also told the Energy and Commerce Health Subcommittee last week that it thought that a public plan could "appropriately" be included among the options made available to individuals and employers. However, the group was concerned that building such a plan on Medicare rates--even though limited to the first three years from inception as proposed in the House draft legislation--would have a negative impact on physician participation, particularly primary care physicians, because Medicare pays PCPs far less than private payers in many markets.

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