Core provisions of House legislation

The Affordable Health Care for America Act moves us closer to our goal of accessible, meaningful, affordable health coverage for all Americans, and I was honored to be a part of this significant and historic milestone.

The Affordable Health Care for America Act represents a uniquely American solution to ensuring access to affordable health insurance for all Americans.

It will drive greater competition, resulting in more affordable choices to individuals and small businesses. It will give security and piece of mind to the countless Americans who worry that they could lose their coverage, or find out that their plan is not as meaningful as they believed. It will drive delivery system reforms to improve the quality and efficiency of healthcare in America. And, this plan will shrink our federal deficit and contain the exploding cost of healthcare in this country for families, businesses and the nation.

Yet, just as we work to ensure that all Americans have access to health coverage, we face a severe shortage of primary care physicians, nurse practitioners, physician assistants, and other primary care providers.  Even without health reform, there will be a shortage of 46,000 primary care physicians by the year 2025, and the number of medical students choosing primary care is continuing to decline. Consider this: In 1985 half of all internal medicine residents chose primary care. Now it is only 20 percent. There is also a significant need to increase the number of nurse practitioners and physician assistants, who both play important roles in providing primary care.

Over 133 million Americans suffer from at least one chronic condition, and these patients benefit the most from regular contact with primary care providers because appropriate intervention can keep conditions from worsening. But, despite the economic and health benefits of coordinated care and early intervention, less than one percent of total healthcare spending and biomedical research is devoted to these efforts.

To address these major policy issues, I worked to ensure that the Affordable Health Care for America Act puts a renewed emphasis on primary care. Healthcare is only meaningful if patients have access to health care practitioners who have the tools and resources to provide the highest-quality, coordinated, personalized care to their patients.

Leading healthcare organizations, including The American College of Physicians, The American Osteopathic Association, The American Academy of Family Physicians, The American Nurses Association, The American College of Nurse Practitioners, The American Academy of Nurse Practitioners, The American Association of Medical Colleges, and The National Physicians Alliance all strongly supported health reform that includes a renewed focus on primary care.
Core primary care provisions in The Affordable Health Care for America Act include:

• Eliminates copayments for preventive care. Beginning in 2010, Medicare and Medicaid beneficiaries will no longer have to pay copayments for preventive care, including mammograms, vaccines, diabetes screenings and other essential services. When the health insurance exchange begins in 2013, private plans will also be prohibited from charging copayments for preventive care.

• Establishes patient-centered medical homes. Medicare will provide additional payments to providers who serve as “medical homes” for their patients with chronic conditions, meaning that they provide comprehensive care-coordination services, flexible hours, and help reduce preventable hospital admissions. This is essential because Medicare beneficiaries with five or more chronic conditions, the group that accounts for 75 percent of Medicare spending, see an average of 13 different physicians per year and are prescribed an average of 50 different prescriptions. Coordination of that care is key to patient satisfaction, better health outcomes, and controlling costs.

•Increases payments to primary care providers. Medicare payments to primary care providers will be increased by 5 percent, and that increase will be 10 percent in Health Professional Shortage Areas.  These new payment rates will reduce the payment inequities between primary care providers and other specialties, encouraging more young people to pursue this important field.

• Provides new scholarships and loan repayments for primary care. New scholarship and loan repayment programs, similar to those available through the National Health Service Corps, will be available to primary care providers who serve in areas with specific shortages of primary care.

• Improves training for primary care providers in outpatient settings. Medical residents will now be able to train in clinics and smaller practices, not just in large hospitals, giving them experiences more relevant to careers in primary care. Nearly 800 residency positions that are currently unfilled will be redistributed to primary care and general surgery programs.

These provisions are integral to enabling us to meet our goals of not only being able to ensure all Americans have access to affordable, meaningful health coverage, but have access to the quality healthcare they need. Renewed focus on primary care, particularly for those with chronic conditions, is essential to meeting our goals of containing costs, while improving the health status of Americans.

Expanded coverage will increase expectations for services, so we must take action now. As health reform moves through the Senate and conference committee it is imperative that we maintain our commitment to these investments in primary care. I encourage my Senate colleagues to recognize the vital importance of primary care in both creating better health outcomes and increasing cost-efficiency in our healthcare system by including strong provisions that reflect this understanding.

Schwartz is a member of the House Budget Committee and the Ways and Means Committee.