AAPI Legislative Day Platform
Wednesday, April 29, 2009
Contact: LegislativeAffairs@aapiusa.net
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Increase the size of entering medical school classes & residency positions nationwide
From 1980-2005, while medical school enrollment remained flat, the U.S. population increased by more than 70 million. Because the percentage of baby-boomer generation doctors (55 and older) rose from 27% to 34% during this time, the Association of American Medical Colleges (AAMC) predicts that 250,000 active physicians will retire by 2020. In order to meet future health care needs, we must increase class sizes for medical schools, the number of residency positions nationwide, and work visas to accommodate highly-skilled physicians.
Protect the 20/220 Pathway and keep medical school affordable
According to the AAMC, average medical student debt in 2007 was $140,000 and the average stipend earned during residency was less than $44,000. Unlike other professions, physicians undergo a lengthy training period upon graduation with little remuneration, making it difficult to pay back federal loans during their residencies. The 20/220 pathway is a federal Economic Hardship Deferment program administered by the U.S. Department of Education, allowing most residents to defer student loan payments for three years using a debt-to-income ratio not exceeding 220% of the Federal Poverty Level. Congress slated this vital program for elimination July 1, 2009 when it passed the “College Cost Reduction and Access Act,” in 2007. AAPI strongly supports permanent reinstitution of this crucial program to assist residents in deferring student loan payments. Without the 20/220 program, medical residents will be forced to pay back a defined percentage of their loans on a monthly basis using a new, untested Income Based Repayment (IBR) program, or have their loans enter forbearance, adding thousands of dollars of interest to their student loan debts. AAPI asks for all Members of Congress to cosponsor the “Medical Economic Deferment for Students (MEDS) Act,” H.R. 1615 and S. 646, to ensure continuation of the 20/220 program.
Supporting IMG visa waivers
International Medical Graduates (IMGs) comprise more than 20% of incoming residents in the U.S. and outnumber U.S. medical graduates by a 3:1 ratio in rural, underserved areas. Additionally, IMGs offer unique experiences from their international backgrounds making their skill-set an invaluable and integral part of their medical practice. Many highly skilled Indian physicians successfully use the J-1 visa to practice medicine in underserved areas across the U.S. AAPI supported H.R. 1127, signed into law on March 20, 2009 (Public Law No: 111-009), which extended the J-1 visa waiver program until September 30, 2009. With many qualified Indian physicians ready to practice medicine in the U.S. and a strong need for health care in underserved communities, AAPI supports continued renewal of the J-1 visa waiver program and urges Congress to renew it when taking up FY 2010 authorization and appropriations bills.
Protecting Medicare and Medicaid Physician Reimbursements
AAPI supports initiatives that protect Medicare and Medicaid physician reimbursements while eliminating unnecessary medical costs. These reimbursements are in constant jeopardy of being reduced, adversely affecting doctors and hindering physician-accessibility for patients. Reimbursement cuts lead to decreased patient-physician time and fewer physicians accepting Medicare and Medicaid patients. Projections by the American Medical Association (AMA) suggest that 45% of physicians would decrease or stop accepting new Medicare patients if the annual reimbursement cuts were to take place. Medicare reimbursements have remained constant from 2001 to 2008 and are expected to decrease by 5% to 10% annually in the near future, despite a growing patient-class of Medicare-eligible citizens. AAPI strongly supports legislation that protects physician reimbursements under the Medicare and Medicaid programs.
Establishing meaningful liability reform nationwide
On any given day, there are 125,000 lawsuits pending against physicians. In 2005, the Physician Insurers Association of America (PIAA) found that 75% of medical liability claims were closed without any payment to the plaintiff. Only 7% of cases went to trial, and in those, physicians prevailed 83% of the time but incurred nearly $100,000 in legal costs. According to the Centers for Medicare and Medicaid Services, medical malpractice insurance premiums paid by physicians rose 15% over just two years. Such steep insurance premium rises fosters an unhealthy environment of “defensive medicine,” where health care costs are inflated by unnecessary tests and defensive spending. Furthermore, states such as Texas that have recently instituted caps on malpractice claims have noted a 30% rise in licensing applications by physicians because they prefer to practice in these “physician friendly” environments. Fewer physicians today practice in areas such as obstetrics and gynecology, surgery, and emergency medicine, due to increased lawsuits and skyrocketing malpractice insurance premiums. AAPI is concerned over these costs, which results in fewer doctors practicing in crucial specialty areas and fewer medical residents willing to enter such fields. AAPI supports federal and state legislation that places effective caps on non-economic damages, limits the use of joint-and-several liability, and limits the statutes of limitations for filing medical malpractice claims.
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