Primary Care Access

Ensure continued access to insurance coverage through the ACA.

To achieve healthy communities, reduce costs, and create equity, the primary care system requires universal and affordable health insurance coverage. Uninsured persons are less likely to seek care, and when they do are often sicker and require more costly or urgent care due to preventable conditions being left untreated.

As health insurance coverage increased under the ACA, more people reported having a regular place to go for medical care. A repeal of the ACA without an adequate replacement plan will lead to uncertainty for the 30 million people who are covered through state health insurance exchanges and Medicaid expansion.

PCDC believes that health insurance coverage should promote access to and utilization of primary care. Specifically, preventive services should be covered without any out-of-pocket costs to ensure ease of access. Furthermore, funding for federal health insurance programs must be — at a minimum — maintained at current levels without shifting costs to states or consumers.

Increase incentives and reduce barriers to provider recruitment and retention.

According to the OECD, over two thirds of primary care doctors and nurses are overqualified for the tasks they perform in their day-to-day work. This waste of human capital must be eliminated for the health care delivery system to function efficiently. PCDC supports primary care strategies that build an adequately trained workforce with an appropriate distribution of skills and tasks.

Additionally, primary care provider and workforce shortages are significant obstacles to increasing access to care. PCDC strongly recommends implementing loan forgiveness and scholarship programs in return for practicing in a primary care setting. This model has been proven to support recruitment and retention of primary care providers.

Reject changes made by the U.S. Department of Homeland Security (DHS) to the “public charge” rule.

As of August 2019, the Department of Homeland Security expanded the long-standing definition of “public charge” from “primarily dependent on the government for subsistence” to anyone who uses — or is deemed likely in the future to use — any government benefits from a vastly expanded list of vital programs that address the social determinants of health.

The availability and accessibility of such programs — Medicaid and Medicare, Low-Income Subsidy, Supplemental Nutrition Assistance Program (SNAP), and federal housing and rental assistance — are central to population health by helping communities address health care coverage, food, and housing. The public charge rule not only hurts patients and their families but also the health providers who serve them.

There are also profound concerns about how the changes to income levels will distress and disrupt the health care workforce and provider pipeline. PCDC strongly supports policy initiatives that reduce the burden this new rule is placing on immigrants and their families.

Increase investment in primary care to increase health care affordability and access, reduce overall cost and improve health outcomes. 

Affordability is a critical component of access to health care. The availability of providers and services to a patient is only relevant if the patient can also afford the cost of the care. Higher levels of comprehensive care with primary care physicians have been associated with lower Medicare costs and hospitalizations. Conversely, higher spending is not associated with better outcomes; the U.S. has some of the worst outcomes in terms of life expectancy at birth, infant mortality, and primary care quality.

Studies show that primary care can bend the health care cost curve — but investments in primary care must go up before total cost of care goes down. PCDC firmly believes that without primary care, families risk illness that can threaten their well-being and financial security as well as worsen health, social, and economic inequities. To meet its responsibility, primary care must be reinforced with sound policies and adequate resources.