WASHINGTON -- Congress needs to do a better job of funding public health priorities and improving the healthcare system, a group of six physician organizations told members of Congress.
Presidents of six physician organizations -- the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American Osteopathic Association, and the American Psychiatric Association -- visited members of Congress as a group here Wednesday to get their message across. The American Medical Association, whose annual Washington advocacy conference takes place here next week, did not participate.
The physician organizations had a series of principles that they wanted to emphasize during their Capitol Hill visits, including:
- Helping people maintain their insurance coverage
- Protecting patient-centered insurance reforms
- Stabilizing the insurance market
- Improving the healthcare financing system
- Addressing high prescription drug prices
The group also released a list of proposed 2020 appropriations for various federal healthcare agencies, including:
- $8.75 billion for the Health Resources and Services Administration
- $7.8 billion for the CDC
- $460 million for the Agency for Healthcare Research and Quality
- $41.6 billion for the National Institutes of Health
- $3.7 billion for the Centers for Medicare & Medicaid Services
One of the group's specific principles revolves around Medicaid funding. "Policymakers should not make changes to federal Medicaid funding that would erode benefits, eligibility, or coverage compared to current law," the group said in its priorities statement.
This would include programs like the work requirements recently approved in Arkansas and other states; the Kaiser Family Foundation reported in January that more than 18,000 Arkansans have been dropped from the Medicaid rolls for failing to meet the work requirements there.
"Our group is very, very supportive of innovation," said Ana Maria López, MD, MPH, president of the American College of Physicians, at a breakfast briefing here with reporters. "We welcome testing and evaluation, but we have a very strong tenet that any effort should first do no harm, so any proposed changes should increase -- not decrease -- the number of people who are insured. Anything that decreases access we should not support."
That includes work requirements, said John Cullen, MD, president of the American Academy of Family Physicians. "When waivers are used in ways that are trying to get people off of the Medicaid rolls, I think that's a problem," he said. "What you want to do is increase coverage."
Lydia Jeffries, MD, a member of the government affairs committee of the American College of Obstetricians and Gynecologists, agreed. "We support voluntary efforts to increase jobs in the Medicaid population, but we strongly feel that mandatory efforts are against our principal tenets of increasing coverage."
More $$ for Gun Violence Research
Gun violence research is another focus for the group, which is seeking $50 million in new CDC funding to study firearm-related morbidity and mortality prevention. Kyle Yasuda, MD, president of the American Academy of Pediatrics, explained that gun research stopped in 1997 after the passage of the so-called Dickey Amendment, which prevented the CDC from doing any "gun control advocacy" -- that is, accepting for publication obviously biased articles and rejecting any articles that found any positive benefits to gun ownership. Although the amendment didn't ban the research per se, the CDC chose to comply with it by just avoiding any gun violence research altogether.
Recently, however, Health and Human Services Secretary Alex Azar and CDC Director Robert Redfield, MD, "have provided assurances that the language in the Dickey Amendment would allow for [this] research," said Yasuda. "We didn't have research to guide us and that's what we need to go back to."
The research is important, said Altha Stewart, MD, president of the American Psychiatric Association, because "in addition to the physical consequences related to gun violence, there's a long-term psychological impact on everyone involved -- both the people who are hurt and the people who witness that hurt. It's a set of concentric circles that emerges when we talk about the psychological effects of trauma. We often think of [these people] as outliers, but for many people we work with, this has become all too common in their lives.
"This is definitely our lane as physicians and I'm glad we're in it," she said, referring to a popular hashtag on the topic.
Yasuda said the effects of gun violence are nothing new to him because he spent half his career as a trauma surgeon in Seattle. "It's not just the long-term effect on kids, it is the next generation of kids ... It's the impact on future generations that this exposure to gun violence has on our society, and we just have to stop it."
The high cost of prescription drugs also needs to be addressed, López said. "We see this every day; people come in and have a list of medications, and you look and see when they were refilled, and see that the refill times are not exactly right ... People will say, 'I can afford to take these two meds on a daily basis, these I have to take once a week' ... They make a plan. [They say] 'I can fill my meds or I can pay my rent.' People are making these sorts of choices, and as physicians, it's our job to advocate for their health."
One thing the group is staying away from is endorsing a specific health reform plan. "We're agnostic as far as what a plan looks like, but it has to follow the principles we've outlined on consumer protection, coverage, and benefits," said Cullen. "As far as a specific plan, we have not decided on that."
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