Medicaid Primary Care Improvement Act

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I rise in support of H.R. 3836, the Medicaid Primary Care Improvement Act, sponsored by Representative Crenshaw from Texas and myself.

As a primary care physician and a Congresswoman, I am excited to see the Medicaid Primary Care Improvement Act come to the floor today.

Allowing Medicaid to utilize the direct primary care model is a huge shift in the way that Medicaid patients and doctors interact for the better. Direct primary care is structurally different than traditional care models, because it is not designed around fee-for-service billing, but, rather, focused entirely on providing patients the best care possible.

This is made possible by having Medicaid pay an affordable monthly fee that, in turn, allows doctors with a set number of patients the time and flexibility to provide the best possible care and the ability to schedule appointments that are the right length in order to provide all of the support those patients need for optimal health.

Some appointments might take 90 minutes. Some might take 10. In the direct primary care model, doctors have a number of patients, or a patient panel, that they are responsible for caring for, and a smaller patient population means more time spent on things like education, preventative care measures, and being able to talk through and address critical topics like nutrition, exercise, stress, and social determinants of health that can't always be thoroughly addressed during a typical time-limited primary care appointment.

In turn, this means better patient understanding of and involvement in their own healthcare, fewer visits to the emergency room, and ideally better outcomes. Other trials of direct primary care have shown exactly those outcomes.

Dr. Garrison Bliss is a pioneer in this effort, starting up the first direct primary care practice in Washington State in 1997. His last year in practice was 2020, the year we were met with COVID. He had just 450 patients with the average patient in their midsixties. Their age put them at an increased risk for COVID morbidity and mortality, and patients in this age group generally require more care or just a smaller-sized panel.

Not a single one of his patients died from COVID during that first year, when we still didn't have vaccinations or treatments and we were still learning about the disease. He credits this to the fact that he could reach them, and they could reach him readily and have conversations about their care and talk with them about their COVID concerns.

He could send out newsletters directly with pertinent information. If his patients had a question about whether or not to go to the emergency room, he was available to give advice by being there for his patients. Consulting with him prevented ER visits with no compromise in care.

This model of care deserves to have more pilots around the country, hopefully with similar results, better outcomes, lower costs, tighter relationships between doctor and patient, and improved patient and physician satisfaction.

If these benefits are consistently achieved, then all people, no matter their level of income or insurance, deserve the option of a direct primary care model, including Medicaid.

I encourage all of my colleagues to vote ``yes'' on H.R. 3836.

Mr. Speaker, I have no further speakers, and I reserve the balance of my time.

Mr. Speaker, I have no further speakers. I am prepared to close, and I reserve the balance of my time.

Mr. Speaker, whatever we can do to expand affordable care, improve healthcare, strengthen the doctor-patient relationship, and bring down costs is a win for our constituents. That is why I am excited to sponsor this bill, the Medicaid Primary Care Improvement Act, that allows the use of direct primary care.

Mr. Speaker, I encourage my colleagues to vote for this bill, and I yield back the balance of my time.

Mr. Speaker, I rise today in support of my bill, the Medicaid Primary Care Improvement Act.

I thank both the chair and the ranking member for their support. I also thank Representative Schrier for being such an excellent co-lead and advocate; and Representatives Smucker, Blumenauer, and Pettersen, who continue to also champion direct primary care.

Mr. Speaker, a lot of attention gets paid to the Members who come down here and raise their voices and scream and yell about all the things they are really mad at because they want the public to know how mad they are. Every once in a while, we can raise our voices and wave our arms for some good things that we all work on together just to improve people's healthcare.

This bill is just that. It is a first step for addressing one of the most important issues in healthcare, which is access. We can promise people health insurance, and we can add more money to it, but it doesn't necessarily translate into actual access to a provider.

Direct primary care is one of the easiest and most direct ways to deliver primary care to patients. It is a payment model that makes sense to patients because it is simple. It is unlimited access to primary care providers by paying a monthly fee. It is a win-win for both patients and doctors because it simplifies and guarantees that relationship.

It keeps patients out of costly emergency rooms. It saves money for the

entire healthcare system. It encourages more efficient preventative medicine, as well. This means treating prediabetes before it becomes diabetes. This means treating heart issues before they become heart disease.

The market has already created direct primary care, and it is a model that actually thrives in districts like mine, where we have doctors like my friend, Dr. Glenn Davis, whose direct primary care practice saves businesses lots of money on their premium payments and also delivers quality care to patients, but, as usual, the government has not caught up.

This bill removes the uncertainty about whether Medicaid can pay for direct primary care access and empowers States with the necessary guidance to provide direct primary care for vulnerable patients who need it most.

It is a game changer because many Medicaid patients aren't accessing primary care right now. They are more likely to show up at an ER than schedule regular visits with a primary care physician, and ER costs keep going up because too many people are not getting the preventative care that they need.

Why? Well, because the truth is a lot of primary care doctors simply can't serve Medicaid patients due to low reimbursement rates. If we allow States to tailor their Medicare programs for direct primary care, which this bill does, we can fundamentally change this dynamic.

Our legislation is straightforward, and it has zero cost. It clarifies that current laws don't prohibit direct primary care arrangements while offering guidance for States that want to use direct primary care in their Medicaid programs, just like my home State of Texas.

Mr. Speaker, I genuinely hope that we can push this forward in a truly bipartisan way.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 3836) to facilitate direct primary care arrangements under Medicaid, as amended.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on the bill.

Mr. Speaker, I yield myself such time as I may consume.

Mr. Speaker, I am proud to support the work today of Congressman Crenshaw, a fierce advocate for primary care access for patients in this country.

Primary care is the backbone of our healthcare system, and we know that investing now in connecting Americans to primary care will keep people healthier and save money along the way.

The Medicaid Primary Care Improvement Act is a straightforward bill that will help clarify current law to ensure that States have the tools and flexibility needed to offer primary care services in a variety of manners and settings through the Medicaid program.

One way to deliver primary care that shows promise is called direct primary care. Direct primary care clinics have been expanding around the country, and allow patients to pay a set amount per month for access to a primary care doctor to help address the basic need of healthcare.

This legislation makes sure that the State could explore an option like this for Medicaid enrollees in their State. It is a simple yet effective bill, and I believe it will lead to better outcomes and save taxpayers dollars in the long run.

Mr. Speaker, I urge all of my colleagues to join me in supporting this bill, and I reserve the balance of my time.

Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. Crenshaw), a strong proponent of this bill, and one of the strongest proponents in Congress for primary care.

Mr. Speaker, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Smucker), a member of the Ways and Means Committee and a good friend of mine.

Mr. Speaker, I appreciate Dr. Schrier and all the work that she has done, all the work that the two gentlemen who spoke as primary sponsors have done on this bill. It is a good bill.

Mr. Speaker, in closing, I urge my colleagues to support H.R. 3836, and I yield back the balance of my time.

Mr. Speaker, I thank Mr. Guthrie for yielding.

Mr. Speaker, I rise today in support of this bill, the Medicaid Primary Care Improvement Act, which I am proud to be an original cosponsor of.

Now, we have heard of the many benefits of direct primary care. Certainly, I have seen that in my community, where we have many patients accessing their care through doctors providing direct primary care, which is receiving primary care services for a simple, flat monthly fee. We have seen that it keeps patients out of emergency rooms, improves health outcomes, and it yields savings. I also believe it will yield savings to the Medicaid program in this case.

This bill clarifies that State Medicaid programs may include direct primary care arrangements and, as I said, will help vulnerable beneficiaries access low-cost and high-quality healthcare services.

I think giving States that flexibility is a great step in the right direction as well. When State Medicaid programs innovate on behalf of their patients, especially with something like this--leveraging value- based care delivery models like direct primary care--I think patients and taxpayers will be the winners.

I would also mention a bill that I have introduced, the Primary Care Enhancement Act, which would allow patients or individuals with health savings accounts to access primary care and have that cost be included as a qualified expense in the HSA. This will be another way to expand access to primary care.

Mr. Speaker, I thank Mr. Guthrie for yielding time, and I thank Mr. Crenshaw for his important work on this bill. I encourage my colleagues to vote ``yes.''