Federal Barriers Prevent Low-Income Americans from Receiving Comprehensive Primary Care

Primary care has been widely accepted as a means to improve health outcomes and prevent or mitigate chronic conditions that may require more costly medical care if left untreated. Many primary care models, such as patient-centered medical homes and Medicaid health homes, use comprehensive primary care to provide patients with high quality, coordinated, patient-centered care. Comprehensive primary care often utilizes multidisciplinary teams of providers, allows more opportunities for patient engagement, and offers better coordination of clinical, behavioral, and social services when compared to traditional primary care. Providing care that has these attributes has been linked to improved health outcomes, increased savings across the health care system, and reduced health disparities.

Despite these promising outcomes, many of the 70,000,000 low-income Americans who are enrolled in Medicaid lack access to primary care services, much less comprehensive primary care. Various federal barriers stand in the way of achieving comprehensive primary care within the Medicaid program. The COVID-19 pandemic has exacerbated these barriers, as stay-at- home orders have caused many individuals to delay or cancel their primary care visits, which may negatively impact their health. Additionally, as unemployment rates continue to rise due to the pandemic, enrollment in Medicaid is projected to increase, further straining the primary care providers who treat Medicaid beneficiaries, making it more difficult to achieve comprehensive primary care.

Working with The Commonwealth Fund, the Bipartisan Policy Center has identified the following federal barriers to achieving comprehensive primary care in Medicaid:

• Insufficient resources for primary care innovation;
• Lack of affordable insurance coverage;
• Primary care workforce shortages; and,
• Ongoing racial, ethnic, and economic disparities in care.

Last week BPC released a new report, Advancing Comprehensive Primary Care in Medicaid, which contains policy recommendations to remove or mitigate these barriers.

Many primary care practices may not have the resources necessary to transform their practices to provide comprehensive primary care. To promote innovation within existing practices, BPC recommends Congress appropriate funding for the Primary Care Extension Program. The program would provide both funding and technical assistance to practices that wish to transform into comprehensive care models, such as Medicaid health homes. Funding from this program can also be used to address social determinants of health within their communities.

Because health insurance coverage is a foundation of access to primary care, BPC recommends Congress level the playing field for states that have not expanded Medicaid, which was first authorized by the Affordable Care Act. Re-opening this option will allow the 13 states that did not participate in the original expansion to receive increased federal funding to help support the newly eligible population if they choose to participate.

To strengthen the primary care workforce, BPC recommends increasing reimbursement rates for primary care services and providers and increasing federal funding for safety-net programs to ensure Medicaid beneficiaries have access to primary care services. The report also recommends increasing the number of J-1 visas for foreign doctors, who are more likely to go into primary care and serve Medicaid beneficiaries than US-trained doctors. Last month, the Trump administration suspended these visas through the end of 2020. Although there are exceptions for health care providers, this may still limit the number of physicians working to provide primary care and fight the pandemic.

Finally, to address racial, ethnic, and economic disparities in the Medicaid program, BPC recommends that Congress should block the implementation of a rule finalized by the Trump administration last month. The final rule reverses Obama-era civil rights protections in the health care system by removing nondiscrimination requirements that protect non-English-speaking Americans and the LGBTQ+ community. During a pandemic that is disproportionately affecting minorities and low-income Americans, access to health care should be expanded for vulnerable groups, not limited.

The COVID-19 pandemic has amplified disparities and brought to light major issues in the U.S. health care system. To improve the health of low-income Americans both now and after the pandemic, a comprehensive approach to primary care should be taken within the Medicaid program. Although progress has been made over the years, the recommendations included in BPC’s report outline a path towards achieving better, more accessible primary care for all.