Text of the Ensuring Access to Primary Care for Women & Children Act

This bill was assigned to a congressional committee on March 12, 2015, which will consider it before possibly sending it on to the House or Senate as a whole. The text of the bill below is as of Mar 12, 2015 (Introduced).

114th CONGRESS

1st Session

S. 737

IN THE SENATE OF THE UNITED STATES

March 12, 2015

Mr. Brown (for himself, Mrs. Murray, Mr. Heinrich, Mr. Schatz, Ms. Baldwin, Mr. Sanders, Ms. Stabenow, Mr. Franken, Mr. Blumenthal, Mrs. Boxer, Mr. Leahy, Ms. Hirono, and Mr. Murphy) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XIX of the Social Security Act to extend the application of the Medicare payment rate floor to primary care services furnished under Medicaid and to apply the rate floor to additional providers of primary care services.

1.

Short title

This Act may be cited as the Ensuring Access to Primary Care for Women & Children Act.

2.

Findings

Congress finds as follows:

(1)

Medicaid plays a key role in providing coverage for millions of working families.

(2)

Medicaid enrollees include families, pregnant women, children, individuals with disabilities, and other low-income individuals. Without Medicaid coverage, many enrollees would be uninsured or lack coverage for services they need.

(3)

In 2014, the Medicaid program covered 69,000,000 individuals, or 1 in every 5 Americans. This number will continue to grow, particularly since the Affordable Care Act significantly expanded eligibility to millions of uninsured adults.

(4)

If all States expand their Medicaid programs, an estimated 7,000,000 women ages 18 to 64 would gain coverage under Medicaid.

(5)

In 47 States and in the District of Columbia, Medicaid pays up to 67 percent less than Medicare for the same primary care services.

(6)

Congress has recognized that low provider participation in Medicaid decreases access to health care. To address this problem, Congress acted to increase Medicaid payments for certain primary care services to be not less than the Medicare payment rates for 2013 and 2014.

(7)

As more Americans become insured and empowered participants in their own health care, demand for primary care services is expected to increase over the next few years.

(8)

According to a study published earlier this year in the New England Journal of Medicine, higher Medicaid payment rates have significantly increased appointment availability for Medicaid enrollees.

(9)

Six in 10 women ages 18 to 44 (58 percent) report they see an obstetrics and gynecology (OB/GYN) physician on a regular basis. They are more likely to see their OB/GYN physician on a regular basis than any other type of provider. Given that women comprise the majority of Medicaid enrollees, it is critical that primary care providers, including OB/GYN physicians, receive sufficient reimbursement to participate in Medicaid.

(10)

Nurse practitioners and other health professionals deliver many primary care services. Applying Medicare’s rates for nurse practitioners and other health professionals encourages greater participation in Medicaid, thereby increasing access to primary care, particularly in underserved areas.

(11)

The enhanced Medicaid reimbursement rate ensures providers have the financial capability to serve their patients’ primary care needs. Furthermore, adding nurse practitioners, physician assistants, certified nurse-midwives, and OB/GYN physicians serving in primary care settings increases access to critical health care services for women and children nationwide.