Compelling research demonstrates that the ever-increasing focus of resources on specialty care has created fragmentation, decreased quality, and increased cost. As noted by the Commonwealth Fund, the design of a system to provide health care coverage to all people “will have a deep impact on its ability to make sustainable and systematic improvements in access to care, equity, quality of care, efficiency, and cost control.” viĪny successful health system reform designed to achieve health care coverage for all must re-emphasize the centrality of primary care, reinvigorate the primary care infrastructure in the United States, and redesign the manner of primary care delivery and payment. Additionally, our health care system must begin to account for and address social determinants that have a profound impact on individual and population health outcomes and costs, such as socioeconomic status, housing and occupational conditions, food security, and the environment. vĮnsuring that all people in the United States have affordable health care coverage that provides a defined set of essential health benefits (EHB) is necessary in order to move toward a healthier and more productive society. However, the rollback of some provisions of these policies has increased the percentage of those uninsured to 15.5%, iv close to what it was one decade ago when our uninsured rate was nearing 17%, with nearly 50 million people uninsured. iii The greatest gains in coverage have occurred among our most vulnerable populations and young adults. The uninsured population reached a historic low of 8.8% under the implementation of these policies. Over the past two decades, policies implemented through the Children’s Health Insurance Program (CHIP) and the Patient Protection and Affordable Care Act (ACA) have extended access to affordable health care coverage to millions of previously uninsured, non-Medicare eligible adults and children. Health care costs continue to increase at an unsustainable rate and quality is far from ideal. The health care system in the United States is uncoordinated and fragmented and emphasizes intervention rather than prevention and comprehensive health management. The intent of this policy document is to give the American Academy of Family Physicians (AAFP) and its Board of Directors the needed advocacy flexibility to consider all options that might come before federal and state governments and the American people in working to achieve the goal of health care coverage for all – a goal based upon AAFP policy which recognizes that health is a basic human right for every person and that the right to health includes universal access to timely, acceptable and affordable health care of appropriate quality. To ensure health care coverage for everyone in the United States through a foundation of comprehensive and longitudinal primary care.
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