AMA Letter Urging the Preservation of Primary Care Payment Increases for Medicaid

The Honorable John A. Boehner
Speaker
U.S. House of Representatives
H-232 U.S. Capitol
Washington, DC 20515

The Honorable Nancy Pelosi
Democratic Leader
U.S. House of Representatives
H-204 U.S. Capitol
Washington, DC 20515

Dear Speaker Boehner and Representative Pelosi:

As organizations representing the majority of the nation's physicians, we write to express our strong opposition to proposals that would eliminate the Medicaid primary care payment increase that was recently finalized in a final rule issued by the Centers for Medicare and Medicaid Services (CMS) and scheduled to be implemented on January 1.

Elimination of this policy further burdens the already challenged Medicaid system of today. 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 more cost-effective coordinated and preventive care services that primary care physicians provide. 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 Medicaid payment increase ensures that Medicaid payments for eligible physician services in all states are no less than Medicare, independent of whether a state has chosen to participate in the Medicaid expansion authorized by the Affordable Care Act (ACA). By doing so, it will improve access to care for persons enrolled in both the existing Medicaid program and persons who may become newly eligible for Medicaid in states that accept the federal dollars to expand Medicaid.

Over the past few years, our nation has taken significant steps towards improving access to health care for the uninsured and underinsured. A principal part of this effort has been the investment in primary care as the foundation of our nation's health care system. Expanding access to physicians, especially primary care physicians, is a priority for federal and state governments, as well as commercial insurance plans. Private and public health care systems are making this investment as a means of improving access to health care for patients and as a means of improving the overall quality and efficiency of care provided.

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. However, 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. This results in reduced access to care for the most vulnerable patients and higher costs to federal and state governments.

Although a principal goal of this Medicaid policy is to improve access to primary care, the policy also increases payments to many subspecialists in internal medicine and pediatrics, with the purpose of increasing participation and access to their services.

A key to achieving our joint goals of ensuring increased access and improved quality is ensuring that Medicaid and Medicare payment policies are aligned with the access and quality goals established by public and private health care systems. 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.

We urge you to oppose elimination of the Medicaid primary care payment increase.

This letter was also sent to the leadership of the Senate. The letters were co-signed by the AMA, the MMS, and more than 100 state medical societies and national specialty societies.

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