Bill Would Extend Health Law Provision Set to Expire this Year that Ensures Doctors Treating Medicaid Patients Receive Reimbursements Not Less than Those Treating Medicare Patients
WASHINGTON, D.C. – With a provision set to expire this year that ensures doctors can continue to treat the 62 million Americans who depend on Medicaid, U.S. Sens. Sherrod Brown (D-OH) and Patty Murray (D-WA) today introduced the Ensuring Access to Primary Care for Women & Children Act. The legislation would extend a provision from the Affordable Care Act (ACA) that ensures reimbursement parity between doctors treating Medicaid and Medicare patients. The legislation would also ensure that other providers who treat women and children – including nurse practitioners and physician assistants – receive sufficient reimbursements that will enable them to participate in Medicaid. The bill is cosponsored by Sens. John D. Rockefeller (D-WV) and Mary Landrieu (D-LA).
“We know that expanding access to Medicaid has not only saved lives, but boosted the economic security of millions of families – allowing Americans to live healthier lives and contribute more to their communities,” Brown said. “Under the health law, more than six million Americans have gained access to health insurance through Medicaid. By aligning Medicaid reimbursement with Medicare rates, we can ensure that these newly insured individuals have access to primary care providers and quality health care. Doctors treating women, children, and families should receive the same treatment as their peers treating Medicare seniors.”
“Access to affordable, quality health care coverage is a fundamental source of economic security for working families across the country. Medicaid plays an essential role in ensuring that families have this coverage, and also provides access to critical health services for women,” said Senator Murray. “By ensuring that Medicaid reimbursements are aligned with Medicare rates, and by expanding eligibility to the providers women are more likely to see on a regular basis, we can help women and families get the primary care that best fits their needs.”
One in five Americans – some 62 million men, women, and children – depend on Medicaid for their health care needs. The Affordable Care Act helped expand families’ access to health care services by aligning the payments that primary care physicians receive through Medicaid with Medicare’s higher payments. Because Medicaid provides coverage for millions of families, as well as access to critical health services for women, this ACA provision has played an important role in meeting the increased demand for primary care. Unfortunately, this provision is set to expire at the end of the calendar year, making it harder for women and families to find affordable primary care providers through Medicaid.
The Ensuring Access to Primary Care for Women & Children Act would extend the alignment of Medicaid payments with Medicare payments, so that working families can continue to see the primary care providers who best meet their needs. The legislation would also expand the alignment in payments to include certain providers who are especially important to women’s health, including obstetricians and gynecologists, certified nurse-midwives, nurse practitioners, and physician assistants.
In addition to extending the current Medicaid payment increase for primary physicians for two years, the Ensuring Access to Primary Care for Women & Children Act would:
- Expand eligibility for the payment increase for primary care services to OB/GYNs, nurse-midwives, nurse practitioners, and physician assistants. Women comprise the majority of Medicaid enrollees across all ages. In 2009, nearly three quarters of adult women enrolled in Medicaid were ages 18-44, of reproductive age. Six in ten women in this age group reported that they see an OB/GYN on a regular basis. Women are more likely to regularly see their OB/GYN than any other type of provider. In addition, nurse-midwives, nurse practitioners, and physician assistants are playing an increasingly important role in meeting growing demand for primary care. It is critical that this broader range of primary care providers receive reimbursement sufficient to participate in Medicaid.
- Support more efficient use of program dollars. By aligning Medicaid payment rates with Medicare rates and expanding this alignment to a broader range of primary care settings, this bill would improve the efficiency of Medicaid dollars. This would help families avoid trips to the emergency room for treatment that is better suited for a primary care provider.
Many experts agree that higher Medicaid payment rates would increase the likelihood of providers accepting new Medicaid patients, increasing access to affordable health care coverage. Research also shows that because nurse practitioners and physician assistants are already trained to deliver many primary care services, extending the pay increase to these professionals could also help increase access to primary care, particularly in underserved areas.
“Medicaid matters for children. In fact, children make up more than half of all Medicaid patients,” said Dr. James M. Perrin, President of the American Academy of Pediatrics. “Although pediatricians care for children covered by Medicaid, on average, they receive less than 70 percent of Medicare payment rates for providing identical services. The American Academy of Pediatrics applauds U.S. Senators Sherrod Brown (D-Ohio) and Patty Murray (D-Wash.) for introducing legislation today that will improve access to care for millions of children from low-income families and with special health care needs by funding appropriate payments for many Medicaid services for two additional years.”
The Ensuring Access to Primary Care for Women & Children Act has been endorsed by:
American Academy of Family Physicians
American Academy of Pediatrics
American Association of Nurse Practitioners
American College of Nurse-Midwives
American Congress of Obstetricians and Gynecologists
American College of Physicians
American Osteopathic Association
National Association of Pediatric Nurse Practitioners
National Nursing Centers Consortium
Society of Hospital Medicine