By Melissa Attias, CQ Roll Call
December 11, 2014 -- Some doctors who treat Medicaid patients will see significant cuts for primary care services next year if Congress adjourns without extending a provision of the health care law, as is widely expected.
The overhaul (PL 111-148, PL 111-152) provided a two-year boost in payments for Medicaid primary care physicians, which was designed to put fees for the federal–state health program for the poor on a par with Medicare. That policy expires at the end of the month and—with the House headed out as soon as Thursday—it seems highly unlikely Congress will come to the rescue.
Advocates had also been pushing lawmakers to address three other provisions in the health law that provided mandatory funding through next September, whose expiration is known collectively as the primary care cliff. They say the funding uncertainty is already affecting the programs, which provide support for community health centers and loan repayment and training for health professionals.
A spokeswoman for Patty Murray, who is widely expected to become the ranking member of the Senate Health, Education, Labor, and Pensions Committee next year, said the four programs continue to be priorities for the Washington Democrat. Barring any last-minute progress, she added, Murray will keep pushing for them next Congress.
But getting them enacted may become an even greater challenge in the 114th, when Republicans control both the House and the Senate. GOP lawmakers will likely be reluctant to extend policies and funding linked to the health law, and all four would cost the federal government money to continue.
Sen. Bernard Sanders said proponents of extending funding for the trio of primary care cliff provisions have not gotten the necessary financial support. He pledged to look at every approach possible to ensure continued support for the three programs.
“At a time when we have a major, major crisis in primary health care in America, if we do not address . . . this cliff problem, millions and millions and millions of people will lose access to doctors and dentists and mental health counseling and low-cost prescription drugs,” said the Vermont independent. “It is an absolute imperative that we address this.”
In a December brief, the Urban Institute estimated that the expiration of the Medicaid primary care payment adjustment would reduce fees for eligible providers by an average of 42.8 percent in 2015. The drop would be steeper in states that are not planning to extend the fee increase using their own money, at 47.4 percent on average. The Kaiser Family Foundation reported in October that 15 states were planning to fully or partially continue the boost using state money, 24 had indicated they were not planning to and 12 were undecided.
David A. Fleming, president of the American College of Physicians, released a statement Thursday criticizing Congress for looking like it will adjourn without repealing Medicare’s physician formula or moving the Medicaid payment extension.
“ACP will continue its efforts to inform the new 114th Congress of the devastating impact such cuts will have on Medicaid patients’ access to primary care, and to seek to get the Medicaid pay parity program renewed early in the new Congress,” he said.
Ray Quintero, vice president of government relations for the American Osteopathic Association, also said his group remains strongly committed to getting the payment bump extended “to ensure physicians remain available to treat our most vulnerable population.”
Although funding for fiscal 2016 wasn’t addressed, the year-end spending deal (HR 83) released this week would provide $1.5 billion in discretionary money for community health centers in fiscal 2015. Combined with $3.6 billion in mandatory funding included in the health law—the funding stream slated to expire at the end of September—that would provide nearly a $1.5 billion overall increase for the centers over fiscal 2014.
The other two primary care cliff provisions—the National Health Service Corps and Teaching Health Centers—are currently funded entirely by the mandatory funding from the overhaul and would as a result lose all money if Congress doesn’t act before Oct. 1. Supporters say addressing the teaching centers is particularly urgent because they have to decide on the number of residents they can take in January. Funding uncertainty could preclude them from taking any.