ACP Action Alert: Urge Congress to Support Medicaid/Medicare Payment Parity for Primary Care!

Internal medicine physician specialists providing primary and comprehensive care continue to face significant financial pressures as a result of the COVID-19 global pandemic but also because Medicare, Medicaid and other payers have long undervalued evaluation and management (E/M) services (office visits and other non-procedural services).  Even before the pandemic, physician practices faced increasing costs and payments that did not keep up with inflation.  

ACP supports legislation that has been introduced in both chambers of Congress that would provide pay parity for primary care services under Medicare and Medicaid.  View joint letters of support for H.R. 1025 (the Kids Access to Primary Care Act) and S. 1833 (the Ensuring Access to Primary Care for Women and Children Act).  Despite the titles of the bills, the pay parity for primary care services would apply to all adult patients as well as children.  We are urging AIMn members to engage with us, as part of a broad-based coalition effort, and urge their members of Congress to cosponsor these bills and pass them in both chambers.  This was one of ACP’s primary “asks” of lawmakers during its May 2021 Leadership Day virtual event!

Background: On average, a clinician treating a Medicaid enrollee is paid about two-thirds of what Medicare pays for the same services and only half of what is paid by private insurance plans. In addition, Medicaid enrollment has increased by more than 8 percent over the past year as a result of pandemic-related job and income loss, making the demand for primary care and pediatric clinicians in the Medicaid program more acute than ever. At the same time, physician practices have faced financial challenges due to decreased visit volume and increased expenses such as personal protective equipment, technology to provide telehealth and infrastructure to administer COVID-19 tests and vaccines. Physician practices that accept large numbers of Medicaid patients face further challenges.

Congress took action to raise Medicaid primary care payment rates to Medicare levels in 2013 and 2014, with the federal government paying 100 percent of the increase. Access improved as a result: for example, the policy change led office-based primary care pediatricians to increase their participation in the Medicaid program. Unfortunately, lawmakers failed to reauthorize the payment increase after 2014.  H.R. 1025 and S. 1833 would bring Medicaid payments for primary care services back in line with Medicare payment levels. H.R. 1025 would also include related primary care services provided by our IM subspecialists, not just primary care internal medicine.

Action Requested: Please call your members of Congress and urge them to co-sponsor H.R. 1025 in the House and S.1833 in the Senate.  

Before you can take action, we need to learn more about you.