To: Advocacy Committee and KAFP Membership

From: W.C. Thornbury, MD, President

Subj: KAFP response to American Health Care Act (AHCA) (aka House Republican Health Care Plan

The Kentucky Academy of Family Physicians exists to improve the health of Kentuckians. We understand that this is best accomplished, in part, by ensuring health care coverage that promotes an established and continuous relationship with family physicians and other primary care health providers.
Our Commonwealth has experienced increased insurance coverage through the ACA over the past few years; that has helped make strides in improving the health of Kentuckians. However, that coverage is tempered with the economic burden that its citizens must offset as more of the expense of Medicaid becomes Kentucky’s responsibility and a less competitive insurance market. Likewise, many citizens take issue with the philosophy of general and specific federal mandates for health insurance coverage.
Kentucky suffers from generally poor health and a challenged populace. It is currently faced with a proportionately higher burden of those over 60 years of age and more elderly disabled people than other states, as well as, currently suffering from a large number with mental health issues—including opioid addiction. Kentucky has over 20 of the 54 nationwide counties with exponential growth of opioid addiction.

Within the current (working) legislation of the AHCA are provisions that are consistent with AAFP’s policy, such as coverage for pre-existing medical problems and addressing poor payment rates for Medicaid patients through primary care. Concerns regarding the affordability of health care coverage, providing health care coverage for all (especially large numbers of lower income population in Kentucky that are apt to lose coverage), coverage for women’s health issues and mental health, and substance abuse coverage still need to be addressed through the legislation process. Furthermore, should Medicaid “block granting” become a consideration to States, it will become necessary to understand how monies are attributed and expected to be spent in order to ensure coverage for as many as possible. There are members of the KAFP that agree and disagree with the AHCA in whole or in part.
Presently, the ACHA proposal intended for replacement of the ACA is not in its final form. Any proposed legislation forwarded by the U.S. House of Representatives will be reviewed and acted-upon by the Senate—which may very well promulgate its own legislative work-product. Should they advance, it would be expected that a bicameral conference committee would then have to adjudicate the particulars of a final piece of legislation for review by the Congress before advancing for presidential consideration. This may be a protracted process.
The AAFP, our national academy, is addressing and supporting these many aforementioned items through their “Speak Out” campaign. Within our state academy, the Advocacy Committee reviews and makes recommendations regarding legislative matters. After a meeting of its members, the chair counsels that we should make our members aware of how to support the AAFP’s efforts. It was the chair’s considered opinion that as we are divided as an organization, to truly represent our membership, we should continue to monitor as an organization and encourage our members to let their opinions be voiced individually and through action with AAFP.

As your president, I view this work by our Advocacy Committee through the prism of a Commonwealth and nation divided on the posture of a newly elected Administration that campaigned on a “repeal and replace” healthcare agenda regarding the ACA. At this time however, no final draft of legislation exists and it may be to the benefit of our membership to monitor the changes as the legislative process continues. Furthermore, the Advocacy Committee could not come to a simple majority consensus on action. Therefore, I have given weight of how pieces of incomplete, proposed legislation may, or may not, come to affect our organization, its membership, and Kentucky.

There are many strong opinions on this matter. It is not possible to engage the Board’s Executive Committee and fully discuss this matter and prepare a considered letter from the Academy before a deadline of noon tomorrow (March 23) at which time any official letter from the KAFP to the House must be submitted.
Therefore, I have made the decision to presently keep this matter between each family physician and their legislators and patients. It is not possible for the Academy to speak on behalf of all members when there is no firm consensus within our working committees or the membership at large. There may come a time in the future for the Academy to consider a position on the AHCA; however, the national Academy speaks on federal legislation on our behalf.

I would encourage members that desire to send letters that address this concern to their Kentucky legislators individually. For members that desire to express their advocacy regarding this transitional legislative process, there is a “chatbot” that contacts members of Congress with a text. The tool is for both sides of an issue and accessed by texting the word RESIST to 50409. From there, a prompt will help connect you to your legislator. An addendum to this document provided by the Committee includes information and data that can be sent to our members on the effects of the AHCA.
I submit this letter for your information and consideration;
And, in this matter and all matters, I remain your humble servant—
William C. Thornbury, Jr., M.D., FAAFP

(See Advocacy Committee Reports Attachments for additional background)

FYI

The Kentucky Academy of Family Physicians has as its Mission Statement

Here are the key points that I think should be in a letter from the KAFP to Kentucky