Senators introduce bill to continue higher Medicaid rates for primary care

With the provision in the Affordable Care Act that provides federal money to states to help them make their Medicaid payment rates for primary care match Medicare rates set to expire at the end of this year, Democratic Senators have introduced a bill to continue federal support for higher Medicaid rates for two more years.

The “Ensuring Access to Primary Care for Women & Children Act” (S.2694) is actually designed to help all Medicaid enrollees, not just women and children, gain better access to primary care services by keeping Medicaid primary care rates at a level thought to better entice providers into accepting new Medicaid patients. According to the American Medical Association, which is lobbying for the bill, research studies show that low Medicaid reimbursement rates can significantly affect a physician’s ability to accept new Medicaid patients into his or her practice.

The problem is significant. According to the bill text, last year, Medicaid covered 62,000,000 individuals, or one in every five Americans. With the expansion of Medicaid under the Affordable Care Act, enrollment in Medicaid and the Children's Health Insurance Program is expected to increase by 12,800,000 by 2016. Who will provide primary care to all of these new Medicaid patients was already a big question made tougher by the potential loss of additional federal funding.

Currently, all but three states have lower reimbursement rates for Medicaid than for the same services under Medicare. In some cases Medicaid pays up to 67 percent less than Medicare for the same primary care services. Expecting every state to step up and increase spending on Medicaid to keep rates from dropping come January 1 may be wishful thinking, notes the AMA. “The AMA believes that all physicians seeing Medicaid patients should be paid at least the Medicare rate to ensure adequate access,” the Association said in a the letter of support for the bill’s sponsors. “We believe this bill is an important step in that direction.”

The bill was introduced by Senators Sherrod Brown (D-Ohio), Mary Landrieu (D-La.), Patty Murray (D-Wash.) and John Rockefeller (D-W.Va.) and is currently under consideration by the Senate Committee on Finance. Prospects for gaining a companion bill in the Republican-controlled House or Senate Republican co-sponsors might improve after the mid-term elections if the Democrats manage to hold onto a majority in the Senate. However, the small 11-page bill has little chance of passage unless attached to a larger must-pass measure, such as a repeal or delay of the sustainable growth rate (SGR) formula for calculating Medicare physician payments. The bill tracking website Govtrack.us gives it only a 1 percent chance of passing on its own.