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Internal medicine physicians recommend key elements to guide state initiatives

Washington -- A white paper that examines various state initiatives to expand access to health insurance, as well as proposals by the President and Congress in support of state efforts, was distributed today by the American College of Physicians (ACP).

The paper, State Experimentation with Reforms to Expand Access to Health Care, also identifies key elements that should be a part of any state-based reform. It is a summary of state efforts to reform health care and recommendations on key elements that should be included in any reform.

ACP recognizes that all states cannot use the same framework to achieve universal coverage and that experimentation with various models is desirable, noted David C. Dale, MD, FACP, president of ACP. In this paper, the College offers 10 recommen-dations to states as they develop models to expand access to care for their residents.

Subtitled A Summary of State Efforts to Reform Health Care and Recommendations From the American College of Physicians on Key Elements That Should be Included in Any Reform, the paper brings together state efforts to expand coverage to states uninsured residents. Many of the proposals already have been signed into law and are in various stages of implementation. Others are proposals by state legislatures and Governors that currently are being debated.

ACP has a long-standing commitment to making affordable health insurance available to all Americans. In earlier papers, it has documented the cost of lack of health insurance and the impact of lack of health insurance coverage on health outcomes and proposed core principles for evaluating proposals to expand coverage.

In 2002, the College outlined a national framework to achieve universal coverage that includes a combination of premium subsidies, tax credits, purchasing groups, insurance market reforms, and expansion of Medicaid and the State Childrens Health Insurance Program (SCHIP). The plan also includes a state opt-out program that allows states to opt out of the national framework and establish their own programs for universal coverage. While little progress has been made to address the uninsured in a comprehensive way at the national level, state policymakers across the country are proposing ambitious and innovative reforms to expand health insurance coverage to individuals in their states. The President and Congress have also announced proposals to support states as they pilot new health reforms.

ACPs 10 recommendations are:

  • State-based health plans should either achieve universal coverage, or should at a minimum result in measurable and substantial reductions in the number of uninsured within the next 5 years.
  • State-based health plans should ensure that all individuals participate in the coverage plan, by applying individual mandates, employer mandates, automatic enrollment in publicly funded plans, or some combination of these approaches.
  • State-based health plans should at a minimum provide coverage for a core package of preventive and primary care services and for catastrophic expenses.
  • States should ensure adequate and stable funding for their state-based health programs by broadly sharing responsibility with the federal government, employers, and individuals within the state.
  • State-based health programs should include incentives to ensure a better balance of primary care physicians to specialists and an adequate supply of primary care physicians.
  • State-based health plans should give individuals the ability to obtain care from a qualified patient-centered medical home.
  • State-based health plans should include reimbursement reforms to support the value of patient-centered care managed by a primary or principal care physician.
  • State-based health programs should include incentives for health information exchange and physicians adoption of Health Information Technology (HIT) to support patient-centered care.
  • State-based health programs should not reduce existing benefits for current Medicaid and SCHIP recipients.
  • State-based programs should not penalize patients for engaging in unhealthy lifestyles but should include positive incentives for well-being and prevention.


Contact: David Kinsman
American College of Physicians

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