In this election year, healthcare issues are being widely debated. Each of the presidential candidates has developed proposals for reform—some more detailed than others. In anticipation of an increasingly significant national debate on healthcare reform, the AAOS Board of Directors approved a position statement on existing government healthcare programs during its meeting on March 3. The statement, developed by the Council on Advocacy, had previously been vetted by several groups within the orthopaedic community.

The new position statement recognizes that programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP) will continue to play a role in providing access to care for the nation’s estimated 46.5 million uninsured, nonelderly individuals. It takes a position on issues such as universal coverage, universal access, accountability, continuity of care, cost containment, external reforms, infrastructure and administration, and quality of care. The statement also outlines principles that should apply to such programs and structural changes that must be made for patients to have high quality, safe, cost-effective medical care in general and, specifically, to obtain necessary musculoskeletal care.

Universal coverage, access issues
To address the issue of universal coverage, the statement reads: The AAOS strongly supports providing individuals consistent access to patient-centered, timely, unencumbered, affordable, and appropriate health care and universal coverage while maintaining that physicians are an integral component to providing the highest quality treatment. The AAOS supports prioritizing the coverage of children under the SCHIP program.

With regard to the issue of universal access, the statement reads: The AAOS supports equity in Medicaid and SCHIP payments with Medicare payment rates; this should be structured as a payment floor under which states could not reimburse providers at levels lower than payment under Medicare. Medicare payment to physicians must be structured so that it remains economically viable for physicians to participate and the flawed sustainable growth rate formula must be replaced.

Recognizing that the Medicaid program is severely underfinanced, the statement calls for state and federal governments to bring the focus back to medical services, saying The AAOS believes that the primary cost containment focus in the Medicaid program should focus on the increased spending associated with long-term care services and not on reducing coverage or eligibility associated with Medicaid acute care benefits.

The statement goes on to say that the AAOS believes that the rationale for a higher state/federal matching rate for SCHIP no longer exists, and the inequity between Medicaid and SCHIP matching rates should be eliminated.

Additional elements
The following are additional elements of the position statement:

• Guaranteeing patients their choice of physicians in Medicaid and SCHIP managed care plans
• Sharing responsibility for stability in Medicaid and SCHIP programs among physicians, hospitals, patients, and the federal and state governments
• Including a minimum benefit package, with specialty care services, in traditional and managed care coverage under Medicaid and SCHIP plans
• Providing “defined benefits” rather than “defined contributions” in Medicaid and SCHIP plans
• Requiring Medicaid and SCHIP programs to provide “continuous coverage,” defined as coverage for one year from the date of eligibility
• Eliminating waiting periods as an eligibility requirement for SCHIP programs
• Enacting tort reform at the federal level
• Enabling SCHIP beneficiaries to purchase private insurance with their SCHIP dollars if minimum benefit guarantees and an SCHIP option are available for those who do not choose private programs

Encouraging federal and state investments in health information technology within Medicaid and SCHIP for the benefit of enrolled patients.

The physician’s role
In addition, the statement underscores that the AAOS supports efforts to increase outreach and education to enroll eligible individuals in these programs. It notes that physicians should not be required to act as immigration agents, and they should be appropriately reimbursed for all medically necessary care.

Because patients are best served when their care is directed by physicians, the AAOS supports a physician-directed care requirement for Medicaid and SCHIP programs. AAOS also supports Medicaid and SCHIP initiatives that would do the following:

• Establish state reporting requirements on access information indicators
• Create a national database of utilization information
• Include access measures as an indicator of quality
• Align Medicaid and SCHIP quality initiatives with Medicare quality initiatives
• Create an advisory council similar to the Medicare Payment Advisory Commission that would focus on SCHIP and Medicaid quality access issues

Click here to view the entire position statement on Existing Government Programs.