We are fortunate to live in a state that balances its budget every year and often has a surplus, which allows for spending on important programs and new initiatives to benefit the residents of the commonwealth, all while keeping our tax rate reasonable. There is a great opportunity to improve the health of our citizens this year by increasing payments to primary care physicians who take Medicaid patients. This will increase the number of these doctors who accept Medicaid.
Increasing the number of physicians accepting Medicaid would improve the health of these patients, who often suffer more chronic diseases requiring regular treatment from a local doctor. This would have a huge impact, since 1.9 million Virginians (22% of us) get health care through Medicaid. Improving the health of our fellow citizens would be a major benefit to our communities.
Many studies have demonstrated the health benefits of having easy access to a primary care physician. Research has demonstrated that communities with more of these doctors have lower death rates from heart disease, cancer and other chronic illnesses and have a longer life expectancy. The Congressional Budget Office in 2024 did a study on the value of primary care and found that more investment in this generated cost savings for Medicaid and Medicare by decreasing expensive hospitalizations and emergency department visits. Thus, increased access to primary care physicians saves health care dollars in addition to improving health outcomes.
Despite these advantages, we spend only 5% of our annual $4.9 trillion on primary care. According to the Commonwealth Fund 2024 Annual Report, other successful wealthy countries invest more than double this percentage (an average of 12%) in primary preventive health care and they have much better health outcomes. Even a small increase would produce big dividends.
The budget reconciliation bill being considered by the General Assembly would also increase Medicaid reimbursement rates for pediatricians and psychiatrists, increasing the number of these doctors accepting Medicaid patients. The 2023 report from the Organization for Economic Cooperation and Development (OECD) showed that the U.S. ranks 32nd out of 38 comparison countries on measures of child health. We have higher rates of infant mortality, accidental deaths and obesity in our children that would surely improve with a consistent source of preventive care. Additionally, we have a mental health crisis in both our kids and adults requiring much more psychiatric care for our population.
Doctors have a moral dilemma now when deciding whether to accept Medicaid. They want to provide care for this needy group, but with reimbursement rates at only 76% of what Medicare pays, they often lose money when doing so due to the high overhead costs of running a medical office. Additionally, caring for these patients is often more time and resource intensive because of their multiple complex diseases that require longer and more frequent appointments. Because of these problems, there are some counties in Virginia that have few or no physicians that accept Medicaid, creating major access problems, particularly in poorer rural areas and other physician shortage areas.
How can you help? There are budget amendments being considered in the Virginia General Assembly that would make Medicaid payments for primary care physicians, pediatricians and psychiatrists in Virginia equal to those of Medicare. Please contact your senator and delegate and express your support for these amendments. This is a small investment that will increase access to care for those who need it most.
Bob Newman, M.D. is a clinical professor of family medicine at Macon & Joan Brock Virginia Health Sciences, Eastern Virginia Medical School at Old Dominion University. He is a member of the Board of Directors of the Virginia Academy of Family Physicians. Email him at newmanrj@evms.edu.