Do doctors make too much money? It depends on who you ask. The public perception is that doctors now overcharge for services to account for the cost of government paperwork while government routinely picks a fee they will pay based on what doctors charge. And the government pays less for Medicaid than Medicare. What expanded dramatically under the Affordable Care Act? Medicaid.

For simple procedures,  primary care and immunization services, a doctor treating a Medicaid patient has been paid 59 percent of what is paid by Medicare and this has meant a need to limit the number of those patients. When a medical office staffer sees the insurance is Medicaid, it puts those patients in a different category, limited by the number of patients they can afford to take on. The expanded system is creating barriers for children and families while telling them they now have free health care.

The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP) and American Osteopathic Association (AOA) are urging Congress to extend the current-law payment parity for primary care and immunization services under Medicaid for at least two years. Absent congressional action, federal support for this policy runs out at the end of the year.

Collectively representing nearly 423,000 physicians, the four lobbying groups met with dozens of congressional offices on Capitol Hill recently.  

The Affordable Care Act increased Medicaid payments for primary care and immunizations services to Medicare levels for the calendar years 2013 and 2014, but funding for this policy expires on Jan. 1, 2015 - insurance companies and doctors were supposedly going to make up for lost revenue by then. The lobbyists urge support for a bill sponsored by Senators Sherrod Brown (D-Ohio) and Patty Murray (D-Wash.), the Ensuring Access to Primary Care for Women&Children Act (S. 2694), which would extend Medicaid-Medicare payment parity for two more years.

"Since children make up nearly half of all Medicaid patients, increasing Medicaid payments for primary care services helps improve access to care for children," said AAP President James M. Perrin, MD, FAAP. "The improved Medicaid payment rates over the last two years have already helped pediatricians better address the needs of children in their communities by providing the resources and support they need to give the best possible care to their patients. In order to sustain improved access to care for children in Medicaid, the parity payments must be extended."

"Without congressional action to extend Medicaid parity with Medicare, primary care physicians will see an abrupt cut to Medicaid payments for the care they provide to low-income families," said AAFP President Robert Wergin, MD, FAAFP. "This could wipe out the progress of ensuring that low-income Americans have access to primary medical care. We know from research that when Medicaid beneficiaries cannot find a physician who accepts new Medicaid patients, they face the same access problems as those who have no insurance. They are less likely to have a usual source of care, which contributes to unnecessary fragmentation and duplication of services." 

An April 2014 ACP-member survey found that of the respondents who indicated they had enrolled in the pay parity program via their state Medicaid programs, 46 percent would accept fewer Medicaid patients in 2015 or drop out of Medicaid entirely in 2015 if the program was allowed to expire on Dec. 31, 2014. If pay parity is not extended, the nation's primary care physicians will face an average pay cut of 41 cents on the dollar for providing primary care services, such as office visits for the treatment of chronic diseases like high blood pressure and diabetes to the more than 65 million Americans enrolled in Medicaid.

"The number of eligible Medicaid beneficiaries, among the most vulnerable patient populations, continues to increase throughout the country," said AOA President Robert S. Juhasz, DO. "Ensuring access to care from physicians to treat the needs of these patients is vital to improving the public health of our citizens, and we believe Congress should extend this important payment parity policy to that end."

"The nation's pediatricians are joined today by family physicians, internal medicine and osteopathic physicians with one resounding message for Congress: unless Medicaid-Medicare payment parity is extended this year, patients' access to primary care will decline," said Dr. Perrin. "We urge our national leaders to help ensure the health of our patients by passing the Ensuring Access to Primary Care for Women and Children Act without delay."