To: The Honorable Mitch McConnell, Majority Leader and The Honorable Charles Schumer, Minority Leader, United States Senate

From: Wanda D. Filer, MD, MBA, FAAFP, AAFP Board Chair

American Academy of Family Physicians, Letter, July 17, 2017

The American Academy of Family Physicians (AAFP), which represents 129,000 physicians and medical students, believes it is time to move beyond our current health care debate that is focused on repealing major portions of current law and seek bipartisan policies that build on our collective successes, address ongoing challenges, and improve our health care system for current and future citizens.

To this end, we offer the following policy recommendations for your consideration.

I. Make health care coverage more accessible and affordable

a. Provide an opportunity for individuals between 55 and 64 years of age, who purchase their insurance in the individual market, to purchase their health care coverage through a Medicare Advantage plan.

(Continues with recommendations to prioritize and promote primary care, to stabilize markets, and other recommendations)…

The inadequacies of the Affordable Care Act, followed by the failure of the Republicans to advance any semblance of a better health care system that they promised us, led a majority of Americans to support single payer reform. Opponents have inundated us with their non-substantive arguments against single payer, whereas many of the supposed proponents have reverted to advocacy of the “politically feasible” approach of incrementalism – particularly protecting and expanding the existing, fragmented system of private and public coverage.

In a couple of months, we have gone from calls for “single payer,” to calls for “single payer, but not now,” and now on to calls reverting to “anything but single payer.” In deflecting single payer, we are again seeing proposals to expand the market of private plans through the addition of a “public option,” or by allowing private purchase of Medicare or perhaps Medicaid. What is left unsaid is that these approaches are public in name only since the insurers will be there to be certain that the design features will make them non-competitive – products that are worse than their own private plans. (This already happened with the public option in ACA before it was completely eliminated after Sen. Joe Lieberman’s tantrum.)

The Board of Directors of The American Academy of Family Physicians (AAFP) is now asking the U.S. Senate to support the private insurance markets by adding a choice of private Medicare Advantage plans for individuals over 55. They have not suggested an option of purchasing coverage under the traditional Medicare program. These are private plans with limited provider networks. Worse, they are overpriced because of favorable selection and gaming of risk adjustment – characteristics of private markets.

This may not seem like a very big deal, but it is, and here’s why.

Last year the AAFP Congress of Delegates passed a resolution calling for a study of “a national publicly-financed, privately-delivered health care system for all Americans” and asking that a report be presented to the 2017 Congress of Delegates meeting to be held mid-September in San Antonio, Texas. The report has been prepared, though access is restricted.

Based on the letter to the United States Senate, it can be surmised that the Board and its MD, MBA Chair likely will not be recommending to the Congress of Delegates that AAFP go on record as supporting single payer reform. The Board’s advocacy for using privatized Medicare to expand coverage does not seem to be consistent with an incremental step towards single payer Medicare for all.

Also to be presented to the Congress of Delegates is a resolution from the New York chapter calling for the American Academy of Family Physicians to endorse a national single payer health care system. Considering that the AAFP leadership has already departed on a different route, we should be concerned about whether this resolution can clear the political barriers in the Congress of Delegates.

AAFP members may want to let their delegates know if they are in favor of AAFP officially supporting single payer reform. AAFP members can also access the restricted report on the study of single payer, which includes the assessment of the Board. They may wish to send a message on the Board’s conclusions. Finally, AAFP members may also want to express their views as to the Board’s proposal to the U.S. Senate to introduce Medicare Advantage private plans as a “public option” – an obvious redirection away from a public single payer system.

AAFP Board of Directors Report F to the 2017 Congress of Delegates: Single Payer Health Care System (restricted access):…

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