AAFP Spearheads Movement to Thwart Proposed Elimination of Payment Provision

The AAFP is taking a leading role in opposing a House measure that would pay for a year-long extension of the Medicare physician payment rate by eliminating a provision in the health care reform act to bring Medicaid payments for primary care services up to at least Medicare levels for the next two years.

The Academy issued a Speak Out alert on Dec. 4, asking its members to contact their legislators in Washington to voice opposition to the provision. In addition, the AAFP and 43 of its state chapters, along with most of nation's other major physician organizations, have signed a joint letter (8-page PDF; About PDFs) to House and Senate leaders expressing strong opposition to the proposal.

"Elimination of this policy further burdens the already challenged Medicaid system of today," says the letter, which was signed by nearly 300 organizations, including the AMA, the American College of Physicians, the American Academy of Pediatrics, and the American Osteopathic Association along with their state and local chapters. "Patients will face obstacles to connecting with a patient-centered medical home and will be forced to rely on episodic, acute care services provided in other settings, foregoing the most cost-effective, coordinated and preventive care services that primary care physicians provide."

The letter also notes that "Policies aimed at improving access to physicians in the Medicaid program are strongly supported by our organizations because we understand that investments such as these lead to better quality of care for patients and decreased costs for state governments."

The Republican-controlled House made the proposal to eliminate the Medicaid payment increase as part of an attempt to pay for a year-long extension of the sustainable growth rate (SGR) formula, thus, blocking a 26.5 percent reduction in the Medicare payment rate called for by the SGR. Eliminating the Medicaid payment provision would save about $15 billion, roughly 60 percent of what is needed to pay for a year-long SGR payment patch.

The House proposal resulted in an immediate and sustained response from the AAFP, which played a key role in drafting and circulating the sign-on letter.

"Our members are dedicated to working individually and collectively to ensure that all patients, including low-income working families who depend on Medicaid, have access to needed primary care services," says the letter.

In 44 states, Medicaid pays less than Medicare rates for primary care services, and the payment increase is a way to close the gap between the two programs and increase access to care, a point made repeatedly in the letter. "The Medicaid payment increase is an important policy that attempts to better align payment rates with cost of care for primary care physicians, thus increasing access to primary care physicians for millions of Medicaid patients."

The organizations also point out that "many physicians do not participate in the Medicaid program due to poor payment rates that, historically, are well below the actual costs of providing care" resulting in reduced access for the nation's most vulnerable patients and higher state and federal costs.