March 26, 2021, 4:08 p.m. News Staff — The Academy this week called for swift passage of a House bill that would raise Medicaid payment rates for primary care services to at least Medicare levels.
Achieving this payment parity, the AAFP and other physician groups said in a March 23 letter to lawmakers, would stabilize primary care practices while mitigating health inequities — badly needed interventions in the wake of the COVID-19 pandemic.
“Inadequate Medicaid payment threatens access to primary and pediatric care for the populations hit hardest by COVID-19,” the groups wrote. “Physician practices already operating on thin or negative margins are still working to make up revenue losses, and many simply cannot afford to accept additional Medicaid patients.”
Meanwhile, pandemic-induced under- and unemployment last year 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,” the letter said.
The letter was sent to the House Energy and Commerce Committee ahead of a hearing that day titled “Building on the ACA: Legislation to Expand Health Coverage and Lower Costs.” It was addressed to Reps. Frank Pallone, D-N.J., Anna Eshoo, D-Calif., Cathy McMorris Rodgers, R-Wash., and Brett Guthrie, R-Ky. The Academy’s co-signatories were the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians and the American Osteopathic Association.
The Academy has advocated steadily for Medicaid payment parity, raising its voice last month as Congress assembled the $1.9 trillion American Rescue Plan. Medicaid pays, on average, 66% of the Medicare rate for primary care services; in some states, the Medicaid rate is 33% of Medicare’s.
“Low Medicaid physician payment rates have historically been a barrier to health care access for enrollees,” the AAFP and its co-signatories said this week. “Physicians cite low reimbursement as the primary reason they are unable to accept additional Medicaid patients. Patients covered by Medicaid experience longer office wait times, and both low-income patients and their physicians report that low reimbursement rates lead to shorter, inadequate visit times.
“Evidence indicates that Medicaid patients’ access to care improved when the Affordable Care Act raised Medicaid primary care payment rates to Medicare levels in 2013-14,” the letter added. “One study found that appointment availability increased during the primary care fee bump and decreased after it expired.”
Among those most affected by these care fluctuations are patient populations that have proved to be most vulnerable to COVID-19, including Black, Indigenous and Hispanic individuals — more than 30% of whom have Medicaid coverage. Changes in Medicaid physician participation also contribute to care shortfalls in rural areas, predominantly Black neighborhoods and other Primary Medical Health Professional Shortage Areas, the groups told lawmakers.
The Academy and its co-signatories also joined 20 other medical and advocacy organizations in a March 16 letter endorsing the House bill.
“Vulnerable populations need coverage that ensures them access to affordable and comprehensive quality care,” that letter said. It was sent to Reps. Kim Schrier, D-Wash., Kathy Castor, D-Fla., and Brian Fitzpatrick, R-Pa., the legislation’s sponsors. Among the co-signatories were the Children’s Hospital Association and the March of Dimes.
The Academy raised similar concerns in a March 19 letter sent in support of the Leading Infrastructure for Tomorrow’s America Act (H.R. 1848). Among other elements, the AAFP lauded that legislation’s proposed $10 billion allocation for community health centers and investments in programs addressing social determinants of health, including funds to upgrade drinking water systems.
“Just as our nation’s infrastructure such as roads and bridges need rehabilitation, similar investments are needed in our health care system to recover from the COVID-19 pandemic,” said the letter, which was sent to Pallone and McMorris Rodgers and signed by Academy Board Chair Gary LeRoy, M.D., of Dayton, Ohio.
Like the Kids’ Access to Primary Care Act, H.R. 1848 is among a raft of bills recently introduced by House members hoping to shore up the Patient Protection and Affordable Care Act. Fourteen of these were to be addressed in the March 23 Energy and Commerce hearing.