American College of Physicians: Internal Medicine — Doctors for Adults ®


Policy briefs

From the September ACP-ASIM Observer, copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

  • Senate failure to pass drug benefit should not derail other reforms
  • ACP-ASIM supports expanding J-1 visa waiver program
  • College supports proposals to improve access to care
  • ACP-ASIM endorses federal liability reform
  • College opposes proposed cuts to teaching hospital

Senate failure to pass drug benefit should not derail other reforms

ACP-ASIM said that the Senate's failure to pass a prescription drug bill in late July should not stop other Medicare reforms. College officials also called on lawmakers to overcome their differences and broaden seniors' access to medical care.

"As physicians, we are deeply distressed that Medicare beneficiaries must continue to wait for a viable prescription drug benefit and other necessary updates to the Medicare program," ACP-ASIM President Sara E. Walker, MACP, said in an Aug. 1 statement.

The statement said that disagreement within Congress about adding a drug benefit should not derail other reforms that will preserve access to care for Medicare patients. Reductions in physician reimbursement mandated by Congress have led to deep cuts that are forcing many physicians to stop accepting new Medicare patients or drop out of the program as a participating provider.

To help remedy the situation, the College called on the Senate to pass Medicare reforms that do the following:

  • Establish an affordable, sustainable prescription drug benefit targeting the lowest-income beneficiaries.

  • Halt cuts in Medicare reimbursement for physicians that will total nearly 20% between 2001 and 2005.

  • Provide meaningful regulatory relief for overburdened health care providers.

(The College's statement is online.)

In an earlier letter to all U.S. Senators, Dr. Walker had pointed out that if not halted, scheduled cuts in Medicare physician fees could total 20% by 2005. Those cuts already threaten patient access, the July 16 letter stated, particularly in rural and medically underserved areas.

Dr. Walker urged Senators to pass measures to halt the fee cuts similar to those included in the Medicare Modernization and Prescription Drug Act of 2002 (H.R. 4954), which the House approved in June. That bill includes physician payment increases of 2% to 3% through 2005 and "temporary but essential" changes in the formula used to calculate physician pay.

The College's July 16 letter is online.


ACP-ASIM supports expanding J-1 visa waiver program

The College urged the Senate to expand the Conrad 20 program, which allows states to assign 20 physicians with J-1 visa waivers to positions in medically underserved areas each year.

In a July 16 letter to the Senate Judiciary Committee, College President Sara E. Walker, MACP, underscored the importance of J-1 visa waiver programs for areas suffering from shortages of health care professionals. The College asked the Senate to support S. 2674, which would expand the number of assigned positions in each state under the Conrad 20 program from 20 to 30 every year.

The College's July 16 letter is online.

In related news, the College urged HHS to take on the role of administering the J-1 visa waiver program.

In a July 10 letter to HHS Secretary Tommy G. Thompson, the College said that HHS is the department best suited to assume responsibility for the visa waiver program. Because of HHS' existing relationships with state health departments, the letter noted, the department has the resources to monitor physicians after waivers are granted. Closer monitoring would curtail abuses of the program and ease fears about national security threats.

The College expressed concern that the program may be in jeopardy. Although the U.S. Department of Agriculture has temporarily reversed a March decision to stop processing J-1 visa waiver applications, the program's long-term future is uncertain.

The College's July 10 letter is online.


College supports proposals to improve access to care

The College came out in support of three new pieces of legislation designed to increase access to care for the uninsured.

ACP-ASIM supported the Senate Finance Committee's approval of two access expansion proposals, the Family Opportunity Act and the Mothers and Newborns Health Insurance Act.

The Family Opportunity Act (S. 321) would grant states the flexibility to extend Medicaid coverage to disabled children whose families earn incomes of up to 250% of the federal poverty level. The Mothers and Newborns Health Insurance Act (S. 724) would allow states to enroll low-income pregnant women in Medicaid and the State Children's Health Insurance Program (S-CHIP).

In a July 15 press release, College President Sara E. Walker, MACP, noted that these proposals would provide much-needed assistance to families with disabled children and help ensure that pregnant women get prenatal care.

The press release is online.

In a July 15 letter, ACP-ASIM voiced support for the Health Insurance Access Act of 2002 (S. 2679), which would let states expand health insurance coverage to parents of children eligible for Medicaid and S-CHIP. The bill would also create new tax credits, premium subsidies and purchasing pools to allow small businesses to obtain less expensive coverage than they can buy on their own.

The letter is online.


ACP-ASIM endorses federal liability reform

With both physicians and patients facing the harsh consequences of "excessive" malpractice litigation, the College endorsed the federal tort reform measures included in the HEALTH Act of 2002 (H.R. 4600).

According to a July 17 statement the College provided to the House Subcommittee on Health, the House bill would guard against continuing premium increases and availability problems while protecting patients against malpractice. The act includes several tort reform provisions, such as a $250,000 cap on non-economic awards, as well as periodic payment of future damages and a sliding scale of contingency fees.

The College's statement is online.

In related news, the National Medical Liability Reform Committee (NMLRC), a group of 35 medical organizations that includes the College, sent a statement to the House subcommittee.

Pointing out that "limitless liability" is now affecting health care services, the NMLRC statement explained that California is not facing a liability crisis because the state passed tort reform measures in 1976. Several of the same measures are included in the HEALTH Act of 2002, which the NMLRC endorses.

The NMLRC statement is online.


College opposes proposed cuts to teaching hospitals

ACP-ASIM called for a halt in proposed cuts to Medicare indirect graduate medical education (IME) payments, which are slated to take effect this October.

In a July 8 letter to Thomas Scully, administrator of the Centers for Medicare and Medicaid Services (CMS), the College noted that the proposed 15% cut would force many of the nation's teaching hospitals to reduce services. The proposal would slash IME payments next year by $800 million and by $4.2 billion over the next five years.

The College asked CMS to inform Congress of the problems related to the cuts so that legislators can develop administrative remedies. Without proper funding, the letter explained, teaching hospitals will be unable to maintain current levels of indigent care.

The College's letter is online.


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