American College of Physicians Urges Politicians to Stop Unwise Health Care Cuts, Provides Alternative Proposals

The American College of Physicians (ACP), a nationwide nonprofit organization of doctors of internal medicine, issued a comprehensive report, entitled “The State of the Nation’s Health Care 2012: How Bad Budget Choices and Broken Politics Are Undermining Progress in Health And What Should be Done About It.”

In the report, the ACP “told Congress that the across-the-board cuts called for in 2011’s federal budget deal needed to be replaced with a framework that would gain health care savings while preserving funding for critical programs,” according to the organization’s website.

The report was issued as part of an annual report by the ACP on the state of the U.S. health care system on January 26, 2012.

The full report is available for download as a 26 page PDF document from the ACP’s website.

The State of America’s Health Care in 2012

In its report, the ACP presents facts and statistics on the state of health care in the U.S. in 2012. Here is ACP’s summary of its findings:

How Bad Budget Choices Can Result in Bad Health Care

The ACP’s report discusses, from the perspective of physicians of internal medicine, the consequences that can be expected from unwise choices in the federal budget.

“Despite the progress being made to improve access, reduce costs, and address physician shortages, recent and proposed cuts in funding for many critical health programs threaten to turn back the clock, endangering the health of millions and threatening access to care for the most vulnerable Americans,” the report states.

“As lawmakers make decisions on how to allocate scarce budget resources, they have a responsibility to ensure that programs crucial to the health of persons receive sufficient support,” the ACP advocates. “Cuts that undermine public health, safety and medical research, reduce access to needed care for vulnerable populations, or exacerbate the shortage of primary care physicians are unwise because they will put the health of millions at risk and may result in higher costs in the future,” the ACP states.

The report then provides statistics showing that unwise cuts in health care spending will harm the nation’s health, in the following ways:

• Cuts to public health programs will endanger the health of the public.
• Cuts in disaster preparedness will undermine the ability of federal, state and local governments to prepare for natural and man-made health care emergencies.
• Medicaid budget cuts will reduce access to care for the most vulnerable Americans.
• Cuts in programs to serve the medically vulnerable create barriers to care for millions of poor Americans.
• Reduced funding for the National Health Services Corps will undermine progress in training more primary care physicians to serve in underserved communities.
• The failure to fund programs to align federal resources with national workforce needs will result in money being spent ineffectively and slow progress in reversing the growing shortage of primary care physicians.
• Quality will be put at risk because of cuts in the federal agency responsible for improving the quality, safety, efficiency and effectiveness of care.

Automatic Across-The-Board Budget Cuts Due to Failure of Congressional “Super-Committee” Will Have Devastating Impact on Health Care, ACP Says

“Of even greater concern to ACP than the reductions made to date is the devastating impact that more across-the-board budget cuts—sequestration—will have on critical programs to protect public health and safety, support medical research, and provide access to the medically underserved,” the ACP states in its report.

Because Congress’ Joint Select Committee on Deficit Reduction (the “Super Committee”) failed to reach an agreement on a deficit reduction package, the Budget Control Act of 2011 mandates across-the-board cuts in defense and non-defense programs, each year, starting in 2013 and continuing for 10 years.

“Most of the discretionary spending arising from the authorization of appropriations in the ACA [the Patient Protection & Affordable Care Act] is subject to automatic spending reductions. These include many of the ACA’s programs to fund the training of more primary care physicians,” the ACP reports.

According to the ACP’s report, the automatic enforcement process specified in the Budget Control Act will:

• “Reduce funding for defense programs by 10.0 percent (in 2013) to 8.5 percent (in 2021), yielding total outlay savings of $454 billion. The cuts likely will include funding for health care for uniformed personnel and their families.
• Reduce funding for non-exempt discretionary programs by 7.8 percent (in 2013) to 5.5 percent (in 2021), resulting in outlay savings of $294 billion.
• Impose a 2 percent cut in Medicare payments to physicians, hospitals, graduate medical education programs, and other providers. For physicians, this cut will be in addition to annual scheduled cuts resulting from Medicare’s Sustainable Growth Rate (SGR) formula.”

“Because the sequestration cuts are set by formula, they do not take into consideration the importance or effectiveness of any particular program or activity—highly effective and critically important programs are cut as much as less effective and less important ones,” the ACP reports.

A Framework for a Better Approach to Health Care Costs Suggested by ACP

“ACP believes that budget cuts that will compromise essential programs to improve the access, quality and safety of health care in the United States must not be allowed to stand,” the ACP states in its report.

“Instead, policymakers should embrace an alternative approach that addresses the true cost drivers behind rising health care costs while preserving funding for essential programs,” ACP advocates.

The ACP indicates that, during the summer of 2011, it sent to the Congressional Super-Committee “a menu of options, generally supported by ACP policies, to reduce health care spending in a fiscally and socially responsible manner.” “According to estimates by the CBO and other experts, the options submitted by ACP would reduce spending on health care by $500 to $800 billion over the next 10 years,” the ACP reports.

Specifically, the ACP recommends the following:

1. “Congress should enact a budget package to replace the $1.2 trillion in sequestration cuts mandated by the Budget Control Act. Such an alternative should achieve equivalent or greater savings while allowing for continued and adequate funding for critical programs to provide access to vulnerable populations, fund graduate medical education, improve and protect public health and safety, prevent and control disease, train more primary care physicians, respond to natural disasters and bioterrorism, and support medical research.
2. To achieve health care savings while ensuring funding for critical health care programs, Congress should:
• Repeal the Medicare Sustainable Growth Rate (SGR) formula and establish a process to transition to more effective, patient-centered delivery and payment system.
• Enact reforms to reduce the costs of defensive medicine.
• Support efforts by the medical profession to promote high-value, cost-conscious care.
• Enact structural improvements in entitlement programs that will make them more effective for patients and result in more efficient use of limited resources.
• Reform federal tax policy to encourage consumers to be more cost-conscious in their selection of health insurance.”

The complete “menu of options” advocated by the ACP is attached to its report, along with the estimates of potential savings, and further details on each proposal are summarized within the report.

More Information

A full copy of the ACP’s report, is available for download as a 26 page PDF document from the ACP’s website.

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