For primary care, the state’s Medicaid program pays doctors, nurses, and midwives about half the rate that Medicare pays. The policy of paying half as much for the same service is inequitable and reduces access to high quality primary care for more than two million of our state’s residents.
These lower reimbursement rates are one reason New Jersey has among the nation’s lowest rates of primary care physicians participating in Medicaid.
This week, we finally have movement on a bill that would change that. The bill, A.4223/S2792, increases Medicaid reimbursement so it’s at least equal to Medicare rates for family and general practice physicians, nurses, physician assistants, general pediatricians, ob-gyns, midwives, and mental health providers. The bill was voted out of the Assembly Health Committee with bipartisan support and moves to the Appropriations Committee. You can read our testimony here.
The bill gets to the heart of the Quality Institute’s mission to improve the safety, quality, and affordability of health care for everyone. We have long recognized that primary care is the foundation of good health care. Access to high quality primary care reduces inappropriate emergency room use, can prevent hospitalizations, furthers health equity, and promotes the overall health and wellness of the people in our state.
The evidence shows that health systems with a foundation of comprehensive primary care achieve better, more equitable health outcomes, and are, ultimately, less costly. We are joined in our call for greater investment in high quality primary care by experts at the National Academies of Engineering, Science, and Medicine and thought leaders such as Ezekiel J. Emanuel, MD, and Farzad Mostashari, MD, who, on the KFF Health News “What the Health?” podcast, both cite greater investment in high quality primary care to reform our health care system. Consensus exists that our current system does not serve us well while costing us too much money as a society.
Indeed, while expensive heroic emergency and specialty care can save the lives of patients with strokes or heart attacks, for instance, quality primary care can prevent those medical emergencies in the first place. Yet we are moving in the wrong direction in primary care spending, which accounted for just 6.5 percent of total health expenditures in 2002 and 5.4 percent 2016. Over this period, only 4.2 percent of the total increase in health expenditures was on primary care.
New Jersey’s Medicaid program now covers over two million people in our state, including half of all our children, and pays for 35 percent to 40 percent of the births in New Jersey. Lack of access can have dire consequences. The urgency is especially acute in perinatal care, where New Jersey ranks 46th nationwide for its high maternal mortality rate — with 36.2 fatalities per 100,000 live births — and Black women are seven times more likely to die in pregnancy related complications than white women.
Medicaid serves a racially diverse population, with 66 percent of non-elderly Medicaid enrollees identifying as Black, Latino, Asian, or mixed race. The current system contributes to racial disparities in access, quality, and outcomes — and leads to fewer choices, less culturally aligned care, and lower quality.
New Jersey has a chance to lead on health equity and to restructure our health care system to place more value on primary care, on time spent engaging and listening to patients, and on developing trusted relationships that promote better overall health. Let’s invest in this type of care for everyone.