ACP details challenges facing the U.S. health care system

American College of PhysiciansJan 28 2011

Legislation should build and improve on 'essential' policies in Affordable Care Act, says nation's largest physician specialty society

"The United States is facing an unprecedented crisis in our health care system," reported J. Fred Ralston Jr., president of the American College of Physicians (ACP), at today's annual State of the Nation's Health Care briefing. "We face a crisis in affordable health insurance coverage. We have more uninsured people than ever before. We still are facing a crisis in access to primary care. Health care costs are increasing at rates that the country-and individual families-can't afford."

ACP detailed the challenges facing the U.S. health care system in its annual report on the status of the nation's health system. It identified decreased access to health insurance coverage; decreased capacity in the health care workforce; and increased health care costs.

Last year, Congress passed legislation as part of the Affordable Care Act (ACA) that addresses these issues. The ACA will make health insurance coverage available to nearly all Americans by 2014. The legislation also begins to address the shortage of primary care physicians by reforming payment systems and by funding primary care training programs. And, finally, it funds pilots of innovative payment and delivery systems and research on comparative effectiveness in an attempt to begin to "bend the cost curve."

"In order to meet these challenges Congress needs to preserve and build upon the ACA's reforms," said Bob Doherty, ACP's Senior Vice President of Governmental Affairs and Public Policy. "However, no legislation is perfect and we seek improvements to the ACA in the coming year. We believe there is an opportunity for Congress and President Obama to seek common ground."

ACP's recommendations for improving health care coverage include:

• The ACA's coverage expansions should be retained and as needed improved and expanded--not repealed.
• Congress should consider giving states an earlier option to design their own systems to cover their residents, as proposed by the bipartisan Empowering States to Innovate Act, introduced in the 111th Congress by Senators Ron Wyden (D-Ore) and Scott Brown (R-Mass).

• Congress should also consider advancing the date by which states can enter into a regulatory agreement to allow the sale of health insurance across state lines.

ACP's recommendations to improve workforce capacity include:

• Congress should fully fund, at no less than the authorized levels set by the ACA, essential "discretionary" programs to ensure a sufficient and well-trained primary care workforce.

• Congress should support the ACA's programs to reform payment and delivery systems to recognize the value of primary care.

• Congress should enact additional legislation to facilitate additional payment and delivery system reforms to recognize and support the value of care provided by internists and other primary care physicians.

ACP's recommendations for slowing the rate of growth in health care costs include:

• Congress should support and build upon the programs in the ACA that have the greatest potential to "bend the cost curve."

• Congress should enact more effective medical liability reforms, including a national pilot program on health courts.

• Medical professional societies should take the lead in developing guidelines based on the best available evidence to reduce misuse and over-use of diagnostic tests and treatments and promote adoption of such guidelines by their members.

• Policymakers, including Congress and President Obama, should join with the medical profession in engaging the public in a conversation about how best to conserve and allocate limited health care resources effectively, rationally, judiciously, and equitably.

During the briefing, ACP released a major new policy paper that proposes a framework for making decisions on conserving and allocating resources at the patient-physician and society levels, based on evidence of value. In the paper, ACP emphasizes the importance of the public being involved in making allocation decisions, noting that the imposition of explicit limits on access to services, such as those that exist in other countries, would not be acceptable to most Americans.

"ACP views necessary health reform not from a partisan or ideological perspective, but from the standpoint of what the evidence tells us will be the most effective course of action," concluded Dr. Ralston. "We cannot continue let a highly-partisan and polarized debate over health care reform legislation take the country's "eye off the ball"-from the continued urgency of implementing reforms to our health care system."