Protecting Access to Primary Care Act: Policy Analysis

Introduction and Legislative Objective

On August 2, 2013, Congresswoman Suzanne Bonamici (D-OR) introduced the Protecting Access to Primary Care Act (H.R. 2986). The primary objective of the proposed legislation was to improve access to primary care for individuals enrolled in Medicaid. The anticipated outcome is that the bill will improve reimbursement rates for nurse practitioners, physician assistants, and other primary healthcare providers. The proposed legislation will make a small but significant change to the Affordable Care Act (ACA), which will motivate primary care providers to serve Medicaid patients (Brooks et al., 2015).

With the current nursing shortage, it is anticipated that the Act will attract at least one million additional nursing professionals into the field. It is clear that the country needs more primary care providers to meet the needs of a growing population (Ricketts, 2013).

Background and Formation of the Legislation

The ACA currently offers increased remuneration rates for physicians. Unfortunately, it has failed to increase reimbursement for other primary care professionals such as physician assistants and nurse practitioners (Ricketts, 2013). For example, if a Medicaid patient visits a physician's office, Medicare will reimburse that physician at 100%. However, if that same patient visits a nurse practitioner's office, Medicare will reimburse the nurse practitioner at less than 100%, even though both providers are delivering the same service to the same patient. This disparity is inequitable. Congresswoman Bonamici introduced this bill specifically to close that reimbursement gap.

Compounding this problem, dramatically rising healthcare costs are making access to care increasingly difficult in the United States. The recent period of economic instability has expanded the number of uninsured Americans as a result of reduced employee benefits and job loss. This trend is projected to continue without intervention. The adverse effects of reduced access to healthcare are producing alarming consequences for the nation's economic health. These conditions contributed to the introduction of the Act, which marks the beginning of a significant transformation in America's healthcare framework. After several attempts to reform the healthcare system, U.S. leadership is pushing for the success of this landmark legislation. The goal is to ensure that most citizens have access to health insurance (Brooks et al., 2015).

Impact on Existing Healthcare Policies and Advanced Practice Nursing

The Protecting Access to Primary Care Act will substantially reshape the healthcare policy landscape within which public health is practiced. Nurse practitioners, physician assistants, and other primary healthcare providers will receive improved reimbursement rates. If passed, the bill will eliminate the current reimbursement gap between physicians and nurse practitioners, addressing a vital omission in the ACA. Medicaid members currently depend on clinical nurse professionals and other primary care specialists to meet their healthcare needs. By granting these providers improved reimbursement rates, the bill will motivate more of them to care for Medicaid patients — a development that is especially critical in underserved and rural regions experiencing shortages of primary care providers.

The Act will also have significant implications for advanced practice nursing (APN). First, it will ensure that advanced practice providers receive equivalent rewards for primary care services rendered to Medicaid beneficiaries as those given to physicians. The Act sets a floor for physician incentives for primary care services within Medicaid, requiring that these incentives equal those applied within Medicare. A second implication is increased funding for Advanced Practice Registered Nurse (APRN) education, particularly for advanced specialties and degrees.

Current estimates indicate that the United States is experiencing a shortage of roughly 10,000 primary care physicians (Ricketts, 2013). After implementation of the Protecting Access to Primary Care Act, demand for primary care providers will increase further. A large volume of patients will seek services from APRNs for wellness and preventive care. In recognition of this nationwide deficit, approximately $50 million has been allocated through the Act to strengthen the advanced practice nursing pipeline.