Expanding Medicaid Relies on Strong Primary Care Workforce, AAFP Leader Tells HHS Secretary

As states decide whether to expand their Medicaid programs based on the provisions of the health care reform law, the success of the expansions will be determined, in large part, by the strength of the primary care workforce. This makes it incumbent on state and federal governments to enact payment reforms and other policies to bolster the nation's primary care infrastructure.

That was one of the main messages delivered by AAFP EVP Douglas Henley, M.D., to HHS Secretary Kathleen Sebelius during a meeting between HHS officials and physician organization representatives at the agency's headquarters on Aug. 3.

Most states are expected to expand their Medicaid programs to the levels called for by the Patient Protection and Affordable Care Act, which likely will create a greater demand and need for primary care physicians and primary care services, Henley said he told Sebelius. He noted that the HHS meeting provided yet another opportunity for the Academy to stress the importance of a solid primary care framework when implementing the health care reform law.

HHS has been meeting with various stakeholders during the past several weeks to generate support for the Medicaid expansions -- which, in large part, would be paid for by federal dollars -- and to explain how broadening the Medicaid program will benefit physicians, providers and patients. Other groups represented at the Aug. 3 meeting were the AMA, the American College of Physicians, the American Osteopathic Association and the American College of Surgeons, among others.

"HHS is urging folks to have an informed and data-driven conversation about the importance of expanding Medicaid," said Henley after the meeting. He noted that HHS officials cited a recent study in the New England Journal of Medicine that compared three states that substantially expanded adult Medicaid eligibility with neighboring states that did not expand eligibility. The study found that Medicaid expansion in those three states led to lower mortality, improved care and greater access among newly covered Medicaid populations compared with similar populations in the states that did not expand Medicaid coverage.

Moreover, according to HHS, the expansions will save money by averting the cost of more uncompensated care.

Henley and other representatives at the meeting, meanwhile, spoke about the importance of providing states with data about what the expansions mean -- how many more people would be covered and how they would be covered, for example.

"The AAFP is planning to provide that data to state chapters in the near future," Henley said.