Federal Policy Updates

State Primary Care Investment Legislative Update:

1. In Washington, SB 5589 was referred to the Health & Long Term Care Committee on January 10, 2022, which would charge the state Health Care Cost Transparency Board with measuring and reporting on primary care expenditures and progress toward increasing spending to 12 percent of total health care expenditures. If passed into law, by the end of 2022 the board would submit a preliminary report to the governor addressing primary care expenditures in the state of Washington.
2. In Nebraska, LB 737 was referred to the Banking, Commerce and Insurance Committee on January 10, 2022 and would create a 15-member primary care investment council to:
   • Develop an appropriate definition for primary care investment.
   • Measure the current level of primary care investment, measured as a part of overall health care spending, by public and private payors in Nebraska.
   • Conduct a comparison of spending on primary care services and health outcomes in Nebraska with surrounding states and nationally.
   • Develop an appropriate target level of primary care investment by public and private payors in Nebraska.
   • Recommend strategies to achieve the target level of primary care investment through alternative payment models.
   • Identify the public health benefits and estimated cost savings that would result from meeting the target level of primary care investment though alternative payment models.
   • Identify solutions to barriers for Nebraska residents from accessing primary care and for health payors and medical providers from investing in primary care.

Last week, the CMS Innovation Center released a refreshed strategic vision for the agency that hopes to achieve equitable outcomes through high-quality, affordable and person-centered care. In the document, the Innovation Center identifies and reflects on lessons learned from the previous decade of work, lays out broad objectives, and defines measures of progress to guide the work of the agency over the next decade.

The strategic objectives include:

1. Drive Accountable Care
2. Advance Health Equity
3. Support Innovations
4. Address Affordability
5. Partner to Achieve System Transformation. 

In a public statement on the new strategy, PCC’s President and CEO, Ann Greiner, praised CMS leaders for “a bold vision and strategy for how to continue transforming the U.S. health system through innovation and a focus on equity" while noting “strong investments in comprehensive, whole-person primary care [are] crucial to its success.”

• American Academy of Pediatrics released a new study that found that over 140,000 children experienced the death of a parent or grandparent caregiver during the COVID-19 pandemic and the risk of losing a caregiver was much higher for children of racial and ethnic minorities.
• Health plans are taking on a larger role in addressing the social drivers of health to achieve health equity. In a report published in September, the Anthem Public Policy Institute explored the affordable housing crisis in California, with a focus on patients experiencing homelessness. The report discusses how Medicaid managed care plans can partner with states to provide resources for individuals experiencing homelessness. Additionally, Humana recently invested $25 million as part of a broad population health campaign to support affordable housing initiatives. PCC board member Dr. Nwando Olayiwola, Chief Health Equity Officer at Humana, said, “Humana is committed to addressing structural and root cause barriers to good health outside of the clinical setting, such as access to healthy food, transportation, social connections and stable housing, to help eliminate unjust differences in health.”
• In a new paper titled “Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians,” the American College of Physicians (ACP) advocates for the patient-centered medical home model for primary care delivery in the Veterans Health Administration by sustaining and strengthening the Patient-Aligned Care Team (PACT) model.
• On Oct. 7, the National Partnership for Women and Families along with over 50 other reproductive justice and Black policy leaders signed a letter to democratic congressional leadership urging them to commit to extending postpartum Medicaid coverage to 12 months and include other equity-focused provisions found in the Black Maternal Health Momnibus Act of 2021 (H.R. 959) in the reconciliation process.
• On Oct. 13, a number of PCC Executive Members (including American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, Catalyst Health Network, and One Medical) signed on to a letter to executive leadership at the White House and HHS to include primary care physician practices in the ongoing COVID-19 vaccine rollout.
• A partnership among Covered California (California’s ACA marketplace), California Public Employees’ Retirement System (CalPERS) and PCC Executive Member Purchaser Business Group on Health (PBGH) will launch a pilot program beginning in 2022 to test practice-level measurement using 11 advanced primary care measures developed by the California Quality Collaborative. 

Congress has turned its attention to a budget reconciliation package (H.R. 5376, Build Back Better Act).  After tough intra-party negotiations, Democrats are now contemplating legislation with between $1.5 and $2.0 trillion. The pressure to limit the bill’s expenditures may pit congressional Democrats against each other over health-related provisions, such as expanding Medicaid to low-income adults in all states, extending American Rescue Plan Act marketplace subsidies, and expanding Medicare benefits to include vision, dental, and hearing. Although these issues may be addressed, health care is not the focus of the bill.
 
During PCC’s Oct. 19 Policy and Advocacy meeting, Jennifer Bell from Chamber Hill Strategies provided insight on the status of the reconciliation bill as it relates to health provisions. Bell expects activity to likely center around strengthening the Affordable Care Act and expanding Medicaid coverage. There are also several critical healthcare provisions that are not included in the current reconciliation negotiations, including telehealth.
 
Democrats feel there is an opportunity to make significant progress and feel tremendous pressure to deliver on campaign promises with this reconciliation package. However, debates have grown as Democrats consider cutting funding for Medicare Advantage to pay for portions of the bill. Additionally, according to Bell, there is a real possibility that the package could fail as deadlines rapidly approach and a lack of trust and sense of urgency stall necessary action on expiring provisions, which include surface transportation funding, the debt ceiling, and the child tax credit.