Alicia Ault

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP's annual State of the Nation's Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country's 'eye off the ball' " of achieving the Affordable Care Act's (ACA's) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation's health care problems.

"Instead of turning away from the ACA's promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP's senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won't go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation's Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians' group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare's Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP's wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won't be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn't bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP's annual State of the Nation's Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country's 'eye off the ball' " of achieving the Affordable Care Act's (ACA's) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation's health care problems.

"Instead of turning away from the ACA's promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP's senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won't go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation's Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians' group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare's Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP's wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won't be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn't bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP's annual State of the Nation's Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country's 'eye off the ball' " of achieving the Affordable Care Act's (ACA's) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation's health care problems.

"Instead of turning away from the ACA's promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP's senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won't go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation's Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians' group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare's Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP's wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won't be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn't bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP’s annual State of the Nation’s Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country’s ‘eye off the ball’ " of achieving the Affordable Care Act’s (ACA’s) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation’s health care problems.

"Instead of turning away from the ACA’s promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP’s senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won’t go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation’s Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians’ group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare’s Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP’s wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won’t be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn’t bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP’s annual State of the Nation’s Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country’s ‘eye off the ball’ " of achieving the Affordable Care Act’s (ACA’s) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation’s health care problems.

"Instead of turning away from the ACA’s promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP’s senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won’t go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation’s Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians’ group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare’s Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP’s wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won’t be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn’t bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP’s annual State of the Nation’s Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country’s ‘eye off the ball’ " of achieving the Affordable Care Act’s (ACA’s) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation’s health care problems.

"Instead of turning away from the ACA’s promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP’s senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won’t go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation’s Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians’ group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare’s Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP’s wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won’t be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn’t bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP’s annual State of the Nation’s Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country’s ‘eye off the ball’ " of achieving the Affordable Care Act’s (ACA’s) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation’s health care problems.

"Instead of turning away from the ACA’s promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP’s senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won’t go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation’s Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians’ group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare’s Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP’s wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won’t be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn’t bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP’s annual State of the Nation’s Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country’s ‘eye off the ball’ " of achieving the Affordable Care Act’s (ACA’s) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation’s health care problems.

"Instead of turning away from the ACA’s promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP’s senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won’t go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation’s Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians’ group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare’s Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP’s wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won’t be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn’t bankrupt our country."

WASHINGTON – The American College of Physicians on Jan. 27 came out strongly against any repeal of the Affordable Care Act, and instead is calling on the White House and Congress to come to an agreement on how to tinker with the bill so that it still meets its objectives of covering more Americans, improving access, and reducing the cost of care.

At the ACP’s annual State of the Nation’s Health Care briefing, President J. Fred Ralston Jr. said that "a highly partisan and polarized debate over health care reform legislation regrettably has taken the country’s ‘eye off the ball’ " of achieving the Affordable Care Act’s (ACA’s) multiple goals, including "ensuring a sufficient supply of primary care physicians and other specialties facing shortages."

Dr. Ralston said that the stage is being set for a self-defeating debate that will only lead to a worsening of the nation’s health care problems.

"Instead of turning away from the ACA’s promise of ensuring access to affordable health insurance to nearly all Americans, the ACP believes that Congress should seek bipartisan common ground on making improvements to it, including giving states more freedom earlier to implement the coverage expansions in a way that best meets their own needs," he said.

Bob Doherty, the ACP’s senior vice president for governmental affairs and public policy, was more blunt about the unfolding political landscape, with Republicans bent on repeal and Democrats intent on preserving every bit of the law intact. Neither side will win, said Mr. Doherty.

"The law won’t go away, as most Republicans hope, but restrictions on funding and enforcement could undermine its effectiveness, as many Democrats fear."

He said it was ironic that Republicans might seek to strip funding from such programs as incentives for establishing electronic medical records, comparative effectiveness, and higher Medicare and Medicaid payments for physicians. Most of these very programs have been championed by Republicans in the past, said Mr. Doherty.

"We know that bipartisan solutions remain possible, if we can move beyond arguing about repeal, to seeking common ground to build and improve upon the Affordable Care Act," he said.

The ACP, in its State of the Nation’s Health Care report, urged the White House and Congress to give states more options to cover their residents, and to do it sooner than called for under the ACA. The physicians’ group is supporting the bipartisan Empowering States to Innovate Act, a bill cosponsored by Sen. Ron Wyden (D-Ore.) and Sen. Scott Brown (R-Mass.).

The White House and Congress should also find a mutually acceptable replacement for Medicare’s Sustainable Growth Rate (SGR), said Mr. Doherty. Instead of eliminating comparative effectiveness programs, Congress should embrace them as a means of reducing health care costs.

Medical liability reform is another area that is ripe for bipartisan solutions, said Mr. Doherty. President Obama supported reform in his State of the Union address and seems open to suggestions, he said. The ACP is backing a bill that would cap noneconomic damages, even though it has little chance of making its way through Congress, Mr. Doherty said. And, the group would like to see pilots of so-called health courts, which would create a no-fault system with specially trained judges.

A key element of the ACP’s wish list for the White House and Congress: a national conversation on "how to conserve and share health care resources effectively, efficiently, judiciously, and fairly, based on the evidence of their clinical effectiveness and value, and in accord with distinctive American values, including individualism," said Mr. Doherty.

That position is more thoroughly fleshed out in a white paper released by the ACP at the briefing, "How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?"

Dr. Ralston said that the ACP believes that "this is the first time a major physician membership society has called for a national consensus on conserving and allocating health care resources and proposed a framework on how to make such decisions."

But, he added, "to be clear, the ACP is not proposing that care be rationed."

The idea is that physicians should have access to the best possible evidence on diagnostics and treatments, and that they should be able to share that with patients and make informed decisions about how to proceed.

The United States already limits access to services just by virtue of the fact that people do not have insurance or because insurance companies limit benefits or require cost sharing, said Dr. Ralston. Other factors that impact access are socioeconomic, racial, and ethnic characteristics of patients, and the availability of physicians and facilities, said Dr. Ralston.

He said that Americans have to address the reality that spending is increasing at an unaffordable pace, and decide how best to allocate limited resources.

"We know it won’t be easy," said Dr. Ralston. "We offer our paper, though, in the fervent hope that it will lead to a nonpartisan dialogue on how best to ensure that spending on health care is sustainable and doesn’t bankrupt our country."

The Food and Drug Administration has awarded orphan drug designation to BioSante Pharmaceuticals' melanoma cancer vaccine.

The vaccine will be used to treat stage IIb-IV melanoma, says the company, in a statement. The Lincolnshire, Ill.–based BioSante estimates that 68,000 people were diagnosed with melanoma in 2010, and that 8,700 died. The FDA grants orphan status for products intended to treat fewer than 200,000 patients in the United States. According to the agency, makers of orphan products are eligible for tax credits and marketing incentives, but they still have to submit the same efficacy and safety data required of other products. Orphan status does not change the timetable for approval.

The BioSante vaccine is in early development at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. It is a "GVAX" vaccine. According to a BioSante statement, it uses cell lines that are genetically modified to secrete granulocyte-macrophage colony–stimulating factor (GM-CSF). The cells are then irradiated to prevent further cell division. The GVAX model is also being used in BioSante products in development for pancreatic cancer, acute myeloid leukemia, and chronic myeloid leukemia.

The Food and Drug Administration has awarded orphan drug designation to BioSante Pharmaceuticals' melanoma cancer vaccine.

The vaccine will be used to treat stage IIb-IV melanoma, says the company, in a statement. The Lincolnshire, Ill.–based BioSante estimates that 68,000 people were diagnosed with melanoma in 2010, and that 8,700 died. The FDA grants orphan status for products intended to treat fewer than 200,000 patients in the United States. According to the agency, makers of orphan products are eligible for tax credits and marketing incentives, but they still have to submit the same efficacy and safety data required of other products. Orphan status does not change the timetable for approval.

The BioSante vaccine is in early development at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. It is a "GVAX" vaccine. According to a BioSante statement, it uses cell lines that are genetically modified to secrete granulocyte-macrophage colony–stimulating factor (GM-CSF). The cells are then irradiated to prevent further cell division. The GVAX model is also being used in BioSante products in development for pancreatic cancer, acute myeloid leukemia, and chronic myeloid leukemia.

The Food and Drug Administration has awarded orphan drug designation to BioSante Pharmaceuticals' melanoma cancer vaccine.

The vaccine will be used to treat stage IIb-IV melanoma, says the company, in a statement. The Lincolnshire, Ill.–based BioSante estimates that 68,000 people were diagnosed with melanoma in 2010, and that 8,700 died. The FDA grants orphan status for products intended to treat fewer than 200,000 patients in the United States. According to the agency, makers of orphan products are eligible for tax credits and marketing incentives, but they still have to submit the same efficacy and safety data required of other products. Orphan status does not change the timetable for approval.

The BioSante vaccine is in early development at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. It is a "GVAX" vaccine. According to a BioSante statement, it uses cell lines that are genetically modified to secrete granulocyte-macrophage colony–stimulating factor (GM-CSF). The cells are then irradiated to prevent further cell division. The GVAX model is also being used in BioSante products in development for pancreatic cancer, acute myeloid leukemia, and chronic myeloid leukemia.

The Food and Drug Administration has awarded orphan drug designation to BioSante Pharmaceuticals’ melanoma cancer vaccine.

The vaccine will be used to treat stage IIb-IV melanoma, says the company, in a statement. The Lincolnshire, Ill.–based BioSante estimates that 68,000 people were diagnosed with melanoma in 2010, and that 8,700 died. The FDA grants orphan status for products intended to treat fewer than 200,000 patients in the United States. According to the agency, makers of orphan products are eligible for tax credits and marketing incentives, but they still have to submit the same efficacy and safety data required of other products. Orphan status does not change the timetable for approval.

The BioSante vaccine is in early development at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. It is a "GVAX" vaccine. According to a BioSante statement, it uses cell lines that are genetically modified to secrete granulocyte-macrophage colony–stimulating factor (GM-CSF). The cells are then irradiated to prevent further cell division. The GVAX model is also being used in BioSante products in development for pancreatic cancer, acute myeloid leukemia and chronic myeloid leukemia.

The Food and Drug Administration has awarded orphan drug designation to BioSante Pharmaceuticals’ melanoma cancer vaccine.

The vaccine will be used to treat stage IIb-IV melanoma, says the company, in a statement. The Lincolnshire, Ill.–based BioSante estimates that 68,000 people were diagnosed with melanoma in 2010, and that 8,700 died. The FDA grants orphan status for products intended to treat fewer than 200,000 patients in the United States. According to the agency, makers of orphan products are eligible for tax credits and marketing incentives, but they still have to submit the same efficacy and safety data required of other products. Orphan status does not change the timetable for approval.

The BioSante vaccine is in early development at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. It is a "GVAX" vaccine. According to a BioSante statement, it uses cell lines that are genetically modified to secrete granulocyte-macrophage colony–stimulating factor (GM-CSF). The cells are then irradiated to prevent further cell division. The GVAX model is also being used in BioSante products in development for pancreatic cancer, acute myeloid leukemia and chronic myeloid leukemia.

The Food and Drug Administration has awarded orphan drug designation to BioSante Pharmaceuticals’ melanoma cancer vaccine.

The vaccine will be used to treat stage IIb-IV melanoma, says the company, in a statement. The Lincolnshire, Ill.–based BioSante estimates that 68,000 people were diagnosed with melanoma in 2010, and that 8,700 died. The FDA grants orphan status for products intended to treat fewer than 200,000 patients in the United States. According to the agency, makers of orphan products are eligible for tax credits and marketing incentives, but they still have to submit the same efficacy and safety data required of other products. Orphan status does not change the timetable for approval.

The BioSante vaccine is in early development at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. It is a "GVAX" vaccine. According to a BioSante statement, it uses cell lines that are genetically modified to secrete granulocyte-macrophage colony–stimulating factor (GM-CSF). The cells are then irradiated to prevent further cell division. The GVAX model is also being used in BioSante products in development for pancreatic cancer, acute myeloid leukemia and chronic myeloid leukemia.

Thirty-eight genetic tests for 48 different cancers have been introduced since 2006, according to a draft report by the Agency for Healthcare Research and Quality.

The AHRQ conducted a survey of diagnostics for the Centers for Medicare and Medicaid Services. The report, "Update on Horizon Scans of Genetic Tests Currently Available for Clinical Use in Cancers," will be used as a reference for internal CMS discussions and to help make decisions on future topics for systematic reviews.

Included in the AHRQ’s survey: genetic variations, panels of genetic markers, measurements of gene expression and transcription products, biochemical biomarkers, topographic genotyping, and cytogenetic tests.

The tests fell into three categories. They were either approved by the Food and Drug Administration or pending approval; conducted in certified labs; or available through the Internet but requiring a physician order.

The largest number of tests is for breast cancer; there were nine, used for prognostic and diagnostic purposes and for therapeutic management. There are also three pharmacogenetic tests for breast cancer. The AHRQ identified six tests for colorectal cancer and four for prostate cancer.

By contrast, only 2 of the 38 tests are for lung cancer.

While aiming to be exhaustive, the survey might not have captured every test available or on the horizon, said the AHRQ in the report. "Genetic testing is a rapidly emerging field with the potential to dramatically influence clinical decision making. Health care providers, patients, payers, decision makers, and consumers can benefit from staying abreast of newly released tests," concluded the agency.

The draft report will be finalized after the comment period, which ends Jan. 14.

Thirty-eight genetic tests for 48 different cancers have been introduced since 2006, according to a draft report by the Agency for Healthcare Research and Quality.

The AHRQ conducted a survey of diagnostics for the Centers for Medicare and Medicaid Services. The report, "Update on Horizon Scans of Genetic Tests Currently Available for Clinical Use in Cancers," will be used as a reference for internal CMS discussions and to help make decisions on future topics for systematic reviews.

Included in the AHRQ’s survey: genetic variations, panels of genetic markers, measurements of gene expression and transcription products, biochemical biomarkers, topographic genotyping, and cytogenetic tests.

The tests fell into three categories. They were either approved by the Food and Drug Administration or pending approval; conducted in certified labs; or available through the Internet but requiring a physician order.

The largest number of tests is for breast cancer; there were nine, used for prognostic and diagnostic purposes and for therapeutic management. There are also three pharmacogenetic tests for breast cancer. The AHRQ identified six tests for colorectal cancer and four for prostate cancer.

By contrast, only 2 of the 38 tests are for lung cancer.

While aiming to be exhaustive, the survey might not have captured every test available or on the horizon, said the AHRQ in the report. "Genetic testing is a rapidly emerging field with the potential to dramatically influence clinical decision making. Health care providers, patients, payers, decision makers, and consumers can benefit from staying abreast of newly released tests," concluded the agency.

The draft report will be finalized after the comment period, which ends Jan. 14.

Thirty-eight genetic tests for 48 different cancers have been introduced since 2006, according to a draft report by the Agency for Healthcare Research and Quality.

The AHRQ conducted a survey of diagnostics for the Centers for Medicare and Medicaid Services. The report, "Update on Horizon Scans of Genetic Tests Currently Available for Clinical Use in Cancers," will be used as a reference for internal CMS discussions and to help make decisions on future topics for systematic reviews.

Included in the AHRQ’s survey: genetic variations, panels of genetic markers, measurements of gene expression and transcription products, biochemical biomarkers, topographic genotyping, and cytogenetic tests.

The tests fell into three categories. They were either approved by the Food and Drug Administration or pending approval; conducted in certified labs; or available through the Internet but requiring a physician order.

The largest number of tests is for breast cancer; there were nine, used for prognostic and diagnostic purposes and for therapeutic management. There are also three pharmacogenetic tests for breast cancer. The AHRQ identified six tests for colorectal cancer and four for prostate cancer.

By contrast, only 2 of the 38 tests are for lung cancer.

While aiming to be exhaustive, the survey might not have captured every test available or on the horizon, said the AHRQ in the report. "Genetic testing is a rapidly emerging field with the potential to dramatically influence clinical decision making. Health care providers, patients, payers, decision makers, and consumers can benefit from staying abreast of newly released tests," concluded the agency.

The draft report will be finalized after the comment period, which ends Jan. 14.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs (2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs (2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs (2011:111-22 [doi:10.1377/hlthaff.2010.1032]).

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

WASHINGTON – Health care spending grew at its slowest rate in 50 years in 2009, as the recession caused Americans, especially those with lower incomes and less insurance coverage, to cut back on their use of physician, hospital, and other health services, according to a report issued Jan. 5 by federal analysts.

The data indicated that Americans specifically reduced their physician office visits in 2009, and in particular, reduced their visits to primary care physicians.

The overall 4% rate of health spending growth followed an increase of 4.7% in 2008. In 2009, the nation’s total health tab was $2.5 trillion, or $8,086 per person, according to the annual analysis of a federal data set called the National Health Expenditure Accounts by economists and statisticians at the Centers for Medicare and Medicaid Services.

The analysts found that even with a low rate of health care spending growth, health care spending increased as a share of the nation’s gross domestic product. Health costs accounted for 17.6% of the GDP, up a record 1% from the previous year.

The recession depressed the GDP, and thus allowed health care to gobble up a larger share, said the federal analysts at a press briefing announcing their findings. The analysis was published in the journal Health Affairs.

The economists and statisticians painted a picture of a nation stunned by job loss and declining incomes. In the past, there has been a lag between a recession and any impact on health costs, largely because it has been thought that people will always need health care, Anne Martin, an economist at the CMS Office of the Actuary, said.

But in 2009, the impact was almost immediate, according to Ms. Martin.

Seventy-one percent of the nation’s health spending was covered by insurance from private or public payers, according to the report. Medicare spending remained steady from 2008 to 2009, but there was a large reduction in spending by private insurers. The government analysts said that this was due in part to a reduction in private coverage. They estimated that private insurance enrollment declined by 6.3 million people or 3.2%.

Medicaid, on the other hand, saw its rate of spending grow by 4%, in part offsetting the slowdown by other payers, said Ms. Martin. More children and working-age adults enrolled in Medicaid as the economy continued to flatten, she said, and also because of provisions of the stimulus bill, or American Recovery and Reinvestment Act. There was a 7.4% increase in enrollment in 2009, compared with a 3% increase in 2008. The federal government bore most of the burden for the spending increase, she said.

Americans also vastly curbed their out-of-pocket spending on health – another reflection of the poorly performing economy, the federal analysts noted.

Hospital care continues to be the largest segment of health spending. At $760 billion, it accounted for at least a third of the nation’s health bill. The growth rate in hospital spending for private insurers was only 3% in 2009, down from 6% in 2008. Medicaid’s spending growth accelerated from 3% to 10%, in part because enrollees used emergency departments for primary care, said the analysts.

Physician spending was the second-biggest category, at $505 billion in 2009. The 4% increase from 2008 was the slowest rate of growth since 1996 – partly a result of fewer Americans going to see the doctor. The analysts cited data showing that 36% of Americans said they had fewer health professional visits in 2009, and 59% of that group said the visit they’d skipped was with the primary care physician.

Instead, they might have gone to outpatient or retail clinics, according to the report. Spending for "clinical services," which is included in the physician services category, grew at double the rate of physician services. The authors wrote that the growth is "consistent with recent reports that retail clinics (a subset of all clinics) have increased in popularity because of their convenience and costs."

Finally, prescription drug spending grew more in 2009 than it did in 2008. Spending, which reached $250 billion, grew 5.3% – faster than the 3.1% growth rate in 2008. The number of drugs dispensed was on par with that before the recession hit. And prices rose more than in 2008, but not as much as in previous years. An increase in the dispensing of generic drugs helped mitigate the overall growth in drug spending, said the analysts.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guidelines for ACO demonstration projects.

The organizations also are hoping to see the guidelines adopted more widely. “The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

The CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, the CMS issued a request for information on ACOs. The agency is expected to issue regulations later, perhaps by early 2011.

The agency has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means for eliminating inefficiencies.

In comments submitted to the CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” Mr. Hackbarth wrote.

Dr. Roland Goertz, president of the AAFP, agreed that ACOs will be crucial to shifting the delivery and payment system.

“If implemented correctly, ACOs may help improve quality and efficiency of care and reduce costs while strengthening the patient-physician relationship in the context of a patient-centered medical home,” he said.

The American Medical Association also has established guiding principles for ACOs. Members approved the 13 principles at its interim House of Delegates meeting in November.

The AMA is concerned that existing antitrust and fraud rules can make it difficult for physicians to participate in ACOs. The organization called for increased flexibility in those laws, and for the FTC to provide explicit exceptions to antitrust laws for ACO participants.

ACO savings should be retained for patient care services and distributed to ACO participants, and the organizations should also be allowed to use a variety of payment models, according to the AMA principles.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guidelines for ACO demonstration projects.

The organizations also are hoping to see the guidelines adopted more widely. “The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

The CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, the CMS issued a request for information on ACOs. The agency is expected to issue regulations later, perhaps by early 2011.

The agency has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means for eliminating inefficiencies.

In comments submitted to the CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” Mr. Hackbarth wrote.

Dr. Roland Goertz, president of the AAFP, agreed that ACOs will be crucial to shifting the delivery and payment system.

“If implemented correctly, ACOs may help improve quality and efficiency of care and reduce costs while strengthening the patient-physician relationship in the context of a patient-centered medical home,” he said.

The American Medical Association also has established guiding principles for ACOs. Members approved the 13 principles at its interim House of Delegates meeting in November.

The AMA is concerned that existing antitrust and fraud rules can make it difficult for physicians to participate in ACOs. The organization called for increased flexibility in those laws, and for the FTC to provide explicit exceptions to antitrust laws for ACO participants.

ACO savings should be retained for patient care services and distributed to ACO participants, and the organizations should also be allowed to use a variety of payment models, according to the AMA principles.

The four biggest primary care physician organizations issued a joint document last month that contained what they believe are important principles to guide the development of accountable care organizations.

The 21 principles were developed and issued by the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association. According to the groups, the principles were submitted to the Centers for Medicare and Medicaid Services for consideration as guidelines for ACO demonstration projects.

The organizations also are hoping to see the guidelines adopted more widely. “The AAP urges adoption of these principles by governments, payers, providers and all others who are involved in the health, well-being and success of America's children and their families,” Dr. O. Marion Burton, president of the AAP, said in a statement.

ACOs are being considered as the underpinning of health reform, changing how health care is delivered and financed. The Affordable Care Act calls for Medicare beneficiaries to be assigned to ACOs, which has spurred some debate.

The CMS is charged with developing regulations on how ACOs will be structured and how Medicare and Medicaid will pay providers that participate. The agency, along with the Federal Trade Commission and the Office of Inspector General of the Department of Health and Human Services, held a public meeting on ACOs on Oct. 5 to gather input.

And in mid-November, the CMS issued a request for information on ACOs. The agency is expected to issue regulations later, perhaps by early 2011.

The agency has been looking at a risk-sharing payment methodology that would reward providers for improved quality and lower costs.

The Joint Principles for Accountable Care Organizations issued by the primary care groups outlines a number of principles that should guide that payment system. For instance, incentives should “adequately reflect the relative contributions of participating physicians,” and practices that participate in ACOs and achieve recognition as medical homes “should receive additional financial incentives,” according to the Joint Principles.

The Medicare Payment Advisory Commission (MedPAC) has backed the ACO concept and the notion of shared savings as a means for eliminating inefficiencies.

In comments submitted to the CMS on Nov. 22, MedPAC Chairman Glenn Hackbarth wrote, “If structured carefully, a shared savings program for ACOs could present an opportunity to correct some of the undesirable incentives inherent in fee-for-service payment and reward providers who are doing their part to control costs and improve quality.”

Shared savings also could “help beneficiaries receive more coordinated care and become more engaged with their care management, particularly if beneficiaries are informed when they are assigned to ACOs,” Mr. Hackbarth wrote.

Dr. Roland Goertz, president of the AAFP, agreed that ACOs will be crucial to shifting the delivery and payment system.

“If implemented correctly, ACOs may help improve quality and efficiency of care and reduce costs while strengthening the patient-physician relationship in the context of a patient-centered medical home,” he said.

The American Medical Association also has established guiding principles for ACOs. Members approved the 13 principles at its interim House of Delegates meeting in November.

The AMA is concerned that existing antitrust and fraud rules can make it difficult for physicians to participate in ACOs. The organization called for increased flexibility in those laws, and for the FTC to provide explicit exceptions to antitrust laws for ACO participants.

ACO savings should be retained for patient care services and distributed to ACO participants, and the organizations should also be allowed to use a variety of payment models, according to the AMA principles.