AAFP Proposes Universal Coverage Plan

Joining the chorus of interest groups offering proposals to increase health coverage for the nation's uninsured, the American Association of Family Physicians Jan. 11 presented "A Strategy to Provide Health Care Coverage for All: A Proposal for Discussion and Comment," a plan to guarantee free basic health services for all individuals in the United States. "Far too many people today ... go without the health services they need simply because they do not have health care coverage," Dr. Douglas Henley, executive vice president of AAFP, said at the Jan. 11 press conference. Dr. Bruce Bagley, chair of the AAFP board, said that the financial obstacles to basic health services pose "the real problem" in today's health care system. AAFP President Dr. Richard Roberts said that the group's proposal focuses on addressing this "fundamental problem" in the country's current health care financing system by guaranteeing universal access to basic, preventive health services (Meredith McGroarty, Kaiser Daily Health Policy Report, 1/12).

Nuts & Bolts
The AAFP plan would guarantee coverage of "basic medical services" to those living in the United States, including illegal immigrants, without deductibles or co-payments (Appleby, USA Today, 1/11). The proposal calls for the establishment of a "public/private oversight entity" similar to the Federal Reserve Board to determine which medical services would qualify as "basic" and thus be included in the coverage plan (McGroarty, American Health Line, 1/12). The proposal also would cover "catastrophic" levels of medical care, with individuals paying only up to $10,000 per year for these services depending on their income (USA Today, 1/11). Employers or individuals would need to purchase private insurance for services falling between basic and catastrophic care (Strategy summary, 1/11). The current plan calls for federal and state coverage programs, such as Medicaid, CHIP and Veterans Affairs, to be left in place, Roberts said (McGroarty, American Health Line, 1/12). Funding for the basic coverage would come from a payroll tax of 3% for employers and 1.5% for employees (USA Today, 1/11). The funds would be collected by the public/private oversight board, and then distributed to the states on a per-capita basis. The program would be administered by the states, with each state given "flexibility" in determining how to administer the basic coverage plan. The program would be monitored by the oversight board, which would check to see whether the states were meeting the obligations imposed by the plan's regulations (Strategy summary, 1/11).

Getting Away From the 'Insurance Model'
Bagley said that the proposal was an effort to "step aside from the insurance model," aiming instead to "assure" basic health services. Carlos Gonzales, a physician in Patagonia, Ariz., added that the insurance industry -- the "often-proposed solution" -- is "failing us in rural areas" (McGroarty, American Health Line, 1/12). The proposal states that "the continuation of an insurance 'philosophy' and utilization of a risk-based insurance approach for funding basic health services ... lends itself to 'risk avoidance' behaviors on the part of purchasers of care" ("A Strategy to Provide Health Care Coverage for All: A Proposal for Discussion and Comment," 1/11). Roberts added, "We can't keep doing what we've been doing because it's not working" (USA Today, 1/11).

Next Steps
Roberts said that the AAFP plan aimed to provide unconditional universal access to basic medical services because "incremental [plans] were not fixing the problem" of the uninsured population's difficulties in accessing health care. However, he added, the plan is "not ... a prescription for action" and still needs some revision. For instance, issues such as coverage for prescription drugs and mental health services have not been fully addressed, he said. AAFP is "welcoming" comment from all individuals, and hopes to create a "dialogue" on its strategies. The AAFP will be accepting comment on the proposal through the end of February, after which it will "resculpt" the plan and present it to its Congress of Delegates early next fall. Then the plan will be presented to business groups and other organizations in order to obtain a "consensus" on a system of action (McGroarty, American Health Line, 1/12). The plan is available online for review and comment at http://www.aafp.org/unicov/.