September 15, 2021, 8:45 a.m. — It’s been six months since the Academy called on lawmakers to quickly pass a then-new bill that would raise Medicaid payment rates for primary care services to at least Medicare levels.
That didn’t happen, and the time since has been extraordinarily eventful and uneasy.
Back then, we reminded Congress that pandemic-induced under- and unemployment in 2020 had led Medicaid and CHIP enrollment to increase by more than 6 million people, making the demand for primary care and pediatric clinicians in the Medicaid program “more acute than ever.”
Now, with the public health emergency stretching once more over the horizon, testing physicians beyond the limits of 2020’s terrible new normal, estimates suggest that more than a million more patients have enrolled in Medicaid. This is thanks in part to a welcome push by the Biden administration to reinforce the Patient Protection and Affordable Care Act. But this has happened without any new scaffolding under primary care physicians to ensure fair payment.
So this week the Academy repeated its call for parity and lobbying for other overdue legislative outcomes. Across a series of virtual meetings with key lawmakers, AAFP President Ada Stewart, M.D., of Columbia, S.C., joined her Group of Six leadership peers on Sept. 14 in asking Senate and House leaders from both parties, as well as staff from key committees, to pass several key bills.
Topping the list, of course, is ensuring that physicians don’t face payment cuts for medical services next year. The bipartisan Kids’ Access to Primary Care Act (H.R. 1025) remains the most immediately realistic way to preserve and expand patient access to care. Really, it’s the minimum Congress can do, given the circumstances (and I hope you’ll echo our call by joining the AAFP’s Speak Out campaign).
The COVID-19 pandemic’s financial pressure on the health care system has arguably hit small medical practices hardest, forcing physicians already under tremendous strain to navigate new bureaucratic challenges as they continue caring for communities in which many of their patients may rely on Medicaid. As long as Medicaid payment rates remain significantly lower than Medicare and private insurance rates — say it with me: Medicaid pays, on average just 66% of what Medicare pays for primary care services — the overall health care system will suffer, and the mission of health care for all will be compromised.
Increasing Medicaid rates for primary care services, as H.R. 1025 does, would help to mitigate health inequities by ensuring that more individuals have access to timely, high-quality primary, pediatric and behavioral health care.
The pandemic also has worsened the U.S. maternal health crisis, revealing anew the deep roots of health inequity experienced by patients of color; Black and Indigenous women number disproportionately high in maternal mortality and severe maternal morbidity. For these reasons, the Academy and its fellow front-line physicians also used their time to urge passage of the Maternal Health Quality Improvement Act (H.R. 4387/S.1675). We believe it’s foundational legislation: It establishes grants to directly address the maternal mortality crisis, supports evidence-based quality-improvement initiatives and takes steps to eliminate racial inequities. The House and Senate versions have advanced out of key committees and deserve swift passage and enactment.
One piece of legislation won’t undo decades of harm overnight. But a failure to pass this necessary, bipartisan effort would perpetuate an international shame.
We’re also advocating for legislation meant to address the substance use disorder crisis and improve the pandemic-tested mental well-being of untold millions of patients. The Collaborate in an Orderly and Cohesive Manner Act, introduced just last week with the Academy’s full-throated support, would promote greater use of the collaborative care model — for now the only evidence-based integrated care model reimbursable in primary care — while eliminating some of the barriers that have kept it from flourishing.
The integration of behavioral health care into primary care is an area of focus for the Academy, and we anticipate that passage of this legislation would advance that aim. Besides being a powerful tool against unacceptable rates of overdose deaths and suicide, it would help us alleviate workforce shortages, increase patient access to mental health and substance use disorder treatment and improve outcomes while lowering overall system costs.
Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.