• In The Trenches

    Our Advocacy Is Building Momentum for Primary Care

    The news for family medicine the past few days has been unequivocally good.

    Group of doctors showing thumbs up

    Earlier this week, the Biden administration announced a near-doubling of Medicare payment rates to clinicians administering the COVID-19 vaccine, in a bid to put more needles in more shoulders in less time, especially among underserved communities. The change, already in place, boosts rates for two-shot vaccinations from around $23 to $40; for single-dose vaccines, the increase is from $28 to $40. The White House also reiterated that the American Rescue Plan Act — about which, more in a minute — fully covers all Medicaid and CHIP beneficiaries’ COVID-19 vaccinations.

    The new rates acknowledge the time that primary care physicians spend counseling patients and answering their questions about the vaccines — as we know patients prefer — and point the way forward for state Medicaid programs and private payers to follow suit and improve equitable access for all patients. (The Academy remains committed to pushing for vaccine distribution to primary care practices, which recent evidence confirms would be an effective strategy to maximize immunization access.)

    It’s policy worth celebrating and is a result for which we have steadily and vociferously lobbied. In December, for instance, we told regulators: “CMS must value the CPT codes for COVID-19 vaccine administration in such a way that the relative value reflects the additional practice expenses associated with administration of the corresponding COVID-19 vaccines.”

    Well, here that is.

    Meanwhile, the $1.9 trillion American Rescue Plan Act, signed March 11, provides investments in health care coverage expansion measures, vaccine reimbursement, COVID-19 response, and the health care workforce, reflecting a number of important wins for family medicine and primary care patients.

    Among the elements of the bill we like best: It answers our calls for medical workforce action by devoting $7.6 billion to community health centers, $800 million to the National Health Service Corps and $330 million to expand the Teaching Health Center Graduate Medical Education program.

    The package also includes incentives for states to extend Medicaid eligibility to women for 12 months postpartum, which will expand coverage access and begin to address the high U.S. maternal mortality rate, an issue the Academy is keenly focused on.

    Speaking of Medicaid, the legislation takes aim at the dozen states holding out against expansion of that program in tandem with the Patient Protection and Affordable Care Act. Specifically, it offers a substantial financial incentive for those states to let more low-income patients access Medicaid.

    “You’ve taken away the argument there is even a minute cost,” Chris Jennings told The Washington Post March 14, talking about whether longstanding Republican opposition to Medicaid expansion is predicated on pure fiscal principle.

    You might recall Jennings — a veteran health policy consultant who worked in the White House during the previous two Democratic administrations — as one of the panelists at our bipartisan “Navigating the Health Care Landscape” discussion at the virtual Family Medicine Experience last October.

    What he told AAFP members last fall holds up well today: “We may be facing one of the most challenging government transitions in our history. And, regardless of outcome, health care will remain at the forefront of the political conversation.”

    Jennings’ co-panelist that day, GOP lobbyist Dean Rosen, didn’t disagree, singling out health inequities as one of that conversation’s key drivers.

    I see a good start to addressing some of those inequities — as we asked Congress to do in January — in the American Rescue Plan. As this March 11 Health Affairs post points out, the law will “expand access to coverage for millions of people, improve affordability for current enrollees and further bolster enrollment during the three-month special enrollment period that runs through mid-May” — changes that the Congressional Budget Office predicts will “extend coverage to about 800,000 uninsured people in 2021, 1.3 million uninsured people in 2022, and 400,000 uninsured people in 2023.”

    Many of those people are minorities whom the system was otherwise leaving behind.

    An HHS fact sheet issued late last week lays out the ways in which the plan “addresses racial health inequities by expanding coverage and reducing costs” and projects some promising numbers:

    • 48,000 uninsured American Indian and Alaska Native individuals will be newly eligible to save money on health care coverage, with 21,000 eligible for zero-dollar benchmark marketplace plans;
    • 730,000 uninsured Hispanic individuals will be newly eligible to save money on health care coverage, with 580,000 eligible for zero-dollar benchmark marketplace plans;
    • 360,000 uninsured Black individuals will be newly eligible to save money on health care coverage, with 328,000 eligible for zero-dollar benchmark marketplace plans; and
    • 197,000 uninsured Asian, Native Hawaiian and Pacific Islander individuals will be newly eligible to save money on health care coverage, with 50,000 eligible for zero-dollar benchmark marketplace plans.

    Regardless of the outcome in that experiment in state politics, then, more Americans who have struggled to secure or maintain adequate health care coverage will find their way to primary care physicians in the months ahead.

    Your Turn

    Save the date for this year’s Family Medicine Advocacy Summit. Our virtual advocacy day happens May 19, following a live training session the night before.

    This is your chance to join colleagues and meet with members of Congress to advocate for family medicine while sharpening your storytelling and political engagement skills.

    There’s no shortage of issues facing the specialty at both state and federal levels, and travel isn’t a concern when the lobbying happens via computer or phone, so I’m hopeful that more of you than ever before will take advantage of this opportunity.

    In the coming weeks, the Academy will post more information about on-demand virtual training on how best to set meetings, share stories from your practice with lawmakers and their staffs and influence the legislative process. Watch the Family Medicine Advocacy Summit webpage for details.


    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.