CIR Joins Other Physicians, Health Care Providers and Advocates to Endorse HR 3962, the Affordable Health Care for America Act

The Executive Committee of the Committee of Interns and Residents/SEIU Healthcare formally endorsed HR 3962, the Affordable Health Care for America Act, an historic and comprehensive health care reform bill which successfully passed the House of Representatives on November 7, 2009.

CIR has evaluated this year’s reform legislative proposals by focusing our attention on four key areas in order to determine whether the bill represented the best interests of our members and the patients we serve.

1.)    Does the bill make health insurance significantly more affordable for our patients?
2.)    Does the bill propose a robust, high-quality public health insurance option designed to compete with private insurance plans and keep them honest?
3.)    Does the bill create the infrastructure changes necessary to build and support the physician workforce of tomorrow?
4.)    Does the bill make meaningful progress towards eliminating disparities based on race and socio-economic status?

No bill is perfect, of course. But HR 3962 addresses and, in most cases, satisfies CIR’s basic criteria. As such, its passage by the House represents an important milestone toward providing quality, affordable health care for all.

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Affordability
Insurers would not be allowed to exclude anyone on the basis of pre-existing conditions, practice rescissions (canceling a policy when a patient gets sick), or selectively refuse to renew coverage. Insurers would not be allowed to set different rates based on gender, health status, or occupation, and would not be allowed to impose a lifetime maximum benefit cap. Although insurers would still be allowed to charge different premiums for the same plan based on age, the bill requires a far more limited and affordable rating system.

The bill would set up a National Health Exchange where comprehensive health insurance plans may be purchased at a subsidized rate for individuals and families making less than 400% of the federal poverty line (approximately $88,000 for a family of four). The amount of the subsidies would be determined on a sliding scale, based on income. The bill would institute a yearly cap on out-of-pocket spending, including co-pays and deductibles. The cap on out-of-pocket spending would also be pegged to income for low- and middle-income families. Importantly, there would be no out-of-pocket cost-sharing for primary and preventative care.

Medicaid, a critical program for many of the communities we care for, would be expanded to all families making less than 150% of the federal poverty line (approximately $33,000 for a family of four). This step alone is estimated to cover an additional 15 million Americans. Additionally, the bill would increase Medicaid reimbursement rates for primary care over a period of three years so that they would be equal to 100% of Medicare rates by 2012 – a long-overdue strengthening of the program which will improve the economic outlook for residents and our safety-net hospitals.

For seniors, the bill would eliminate the Medicare Part D “doughnut hole” for prescription drugs and allow the federal government to negotiate for the best deals for pharmaceuticals, two changes that will help seniors in dire financial straits.

Taken together, these provisions would have a dramatic effect on the welfare of our patients and the financial health of our hospitals.


Public Option
According to a study conducted by Robert Wood Johnson Foundation, 62.9% of physicians support giving patients the choice between private insurance plans and a robust public health insurance option, administered by the government in a manner similar to Medicare. The so-called public option is likewise popular with CIR’s membership. We have made and will continue to make the case for giving such a choice to our patients. We believe that having the choice of a public option will help make health care more affordable for patients, foster greater competition in the insurance market, and guarantee that quality, affordable coverage will be there for our patients no matter what happens.

The public option as envisioned by HR 3962 leaves it up to the physician whether to accept patients on the plan or not, and is required to negotiate reimbursement rates with providers and hospitals. From this level playing field, we believe that it will be able to force private insurance to compete for millions of customers on cost and affordability, creating the incentive to transform the way coverage works, system-wide.


Providing for the Physician Workforce of Tomorrow
HR 3962 contains more funding for the National Health Service Corps, as well as new scholarship and loan repayment programs for primary care providers, particularly for those willing to work in areas of need. The bill would encourage primary care residencies in non-hospital settings like community health clinics, and supports the training of physicians in coordinated care settings. It would strengthen existing programs to promote diversity in the health workforce, and expand and authorize grants to promote interdisciplinary and community-based training. Finally, it would invest in Health IT and comparative effectiveness research so that all physicians are armed with the latest information and best practices.


Eliminating Health Disparities
HR 3962 tackled the complex issues of health disparities by finally setting standards for the collection of data on a broad set of population and subpopulation categories, allowing the Department of Health and Human Services to track and analyze persistent disparities in care. The bill contains a substantial investment in language services and in scholarship programs to encourage more diversity in the health care workforce. Additionally, it would establish grants for numerous community-based prevention and wellness programs specifically aimed at reducing health disparities. An analysis of the public health initiatives contained in the bill reveals that more than half of the funding for preventative health grants will go to projects that primarily address disparities.

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Not all CIR issues relating to health care reform are addressed as strongly, but the bill as a whole represents a major step forward in reforming our broken system.


We stand with other physician groups in support of our patients.
HR 3962 has been endorsed by the American Academy of Family Physicians, the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Association for Geriatric Psychiatry, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American College of Surgeons, the American Gastroenterological Association, the American Medical Association, the American Medical Student Association, the American Osteopathic Association, the American Psychiatric Association, the American Public Health Association, Doctors for America, and the National Physicians Alliance. Taken together, these organizations represent over half a million doctors.

CIR is proud to add our voice to theirs on behalf of quality, affordable health care for all.