Marginalized Communities Need More Doctors

Medicare policy must help address shortages—Not push physicians out of high-need areas.

By Dr. Julianne Malveaux —

Unequal access to high-quality health services is one of the most pervasive problems in America’s healthcare system. Far too often, communities of color face reduced access, higher costs, and less comprehensive care and support than their predominately white counterparts.

While this has been a growing cause for concern for decades, several factors – including the economic impact of the COVID-19 pandemic, ongoing supply chain issues, the increasing cost of providing medical care, high inflation, and a growing healthcare workforce shortage – have brought health equity issues to the fore. Add to that a broken Medicare physician payment system that is reducing access to care nationwide, and you have a recipe for disaster.

Throughout the Los Angeles region, there are a troubling number of federally designated Health Professional Shortage Areas, with disproportionately low-income, Black, and Latino neighborhoods seeing the greatest need. According to the California Health Care Foundation, low-income Californians are the least likely to have access to a regular healthcare provider, and Black and Latino Californians are more likely than white Californians to report waiting longer than reasonable for a doctor’s appointment. California is not the only place that will experience improvements in health care access with the passage of HR 2474, but its diverse population give us an idea of which populations will gain most if it will successfully pass.

According to a study by the Commonwealth Foundation, Black Medicare beneficiaries are more likely than white ones to be hospitalized or seek care in an emergency department setting to treat health conditions that could be manageable if they had appropriate access to primary care. This dire lack of primary care is forcing many patients of color to seek out the care they need in higher-cost settings like hospitals and emergency rooms, further compounding the access and affordability issues with which these vulnerable patients must contend.

A survey conducted by the Pew Research Center found that more than six in 10 Black adults say less access to quality medical care in the communities is a “major reason” why Black Americans generally have worse healthcare outcomes than other adults.

Smart public policy should help increase access to primary care to improve patient outcomes, reduce healthcare costs, and prevent underserved communities from relying on hospitals and emergency departments to treat a range of health conditions that could be better and more affordably managed by physicians.

Unfortunately, however, current Medicare policy is doing just the opposite. Longstanding issues in Medicare’s physician payment system have put the program on an unstable, unsustainable path, threatening to further undermine access to primary care––particularly in underserved communities that are already reeling from a shortage of doctors.

You might think that the federal government would be doing everything it can to get more doctors into the field, especially in Health Professional Shortage Areas—but in fact, Medicare reimbursement to doctors has declined by 29% since 2001, when adjusted for inflation in practice costs, according to the American Medical Association.

As if that wasn’t bad enough, the Centers for Medicare and Medicaid Services (CMS) continues to chip away at the already low reimbursements physicians do receive. After imposing cuts on doctors five years in a row, CMS is again proposing to slash Medicare reimbursement by 2.8% in 2025.

By failing to properly reimburse physicians for the true cost of providing care, CMS is forcing many independent physician practices to stop seeing new Medicare patients, scale back staffing or the services they provide, accept buyout offers from larger hospitals and health systems, or else close their doors. Any one of these scenarios is detrimental to patients, particularly in communities of color, where access is already scarce. Failure to fix this problem will only make it harder for Black, Latino, and low-income seniors to get medical care.

There are many solutions that could help improve access to primary care for communities and patients of color, but one thing lawmakers could do immediately is work together to pass the Strengthening Medicare for Patients and Providers Act (HR 2474). This bipartisan legislation, which has 164 cosponsors, would make critical updates to the Medicare physician payment system to help protect and improve access to primary care.

In this toxic environment, Speaker Mike Johnson seems unlikely to schedule a vote on this critical legislation. But he could make the rare effort to exhibit rare bipartisanship, schedule a vote on this legislation, help pass legislation and pass schedule a vote for on 2474, something that millions of seniors would benefit from. Physicians should be receiving the same inflation-based payment updates as all other Medicare provider types like hospitals and nursing homes.

While there would still be much work to do to help improve health equity across in this nation, this legislation would go a long way in improving access to primary care for the patients and communities of color that need it most.