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Posted: February 18th, 2024
Primary Health Care Improvement Act of 2024: An Analysis
Primary health care is the backbone of a high-performing and equitable health system in the United States. Despite its vital importance, access to high-quality primary care is uneven, especially in under-served and rural communities. Lawmakers are introducing legislation to address this very urgent situation: The Primary Health Care Improvement Act of 2024 is a bill that seeks to strengthen primary care infrastructure and workforce capacity.” The purpose of this paper is to explore the legislative intent, stakeholders, target populations, and current status of the bill; while providing an analysis of what implications this will have for the U.S. healthcare system. In addition, it has come with testimony in support of passage, noting the positive impact that strong primary care is having on health outcomes.
Legislative Intent and Scope
This week, lawmakers introduced the Primary Health Care Improvement Act of 2024 — aimed at increasing primary care services across the country. The bill specifically provides funding to increase access to community health centers and to expand the practitioner hiring initiative, with a goal of doubling the total number of patients served at these facilities (Congress. gov, 2024). It also favors innovative modalities of care delivery, like telehealth and school-based health centers, to improve access. It also creates a workforce commission to tackle shortages of primary care providers, especially in rural and underserved areas, and implements a loan repayment program to encourage work in such areas (National Association of Community Health Centers [NACHC], 2024). If implemented at scale, these measures will collectively improve access to healthcare services, improve population health, and narrow gaps in access to care.
Evidence makes clear the need for this effort. According to a report, there are more than 100 million Americans living in a primary care provider shortage area (HRSA, 2023). The bill fills a well-documented hole in the current system by investing in community health centers, which serve as essential safety nets. In addition, the renewed focus on workforce development supports evidence demonstrating that sufficient numbers of staff promote higher quality of care and improved patient satisfaction (Bodenheimer & Smith, 2018).
Available Stakeholders: Supportors and Adversaries
The bill is backed by a coalition of healthcare organizations and advocacy groups. The NACHC has worked closely with the American Academy of Family Physicians (AAFP) to support the legislation, which NACHC believes will improve care delivery in underserved communities (NACHC, 2024). And patient advocacy groups support the bill, saying that expanded access alleviates financial burdens on at-risk populations (Health Affairs, 2024). Many Democratic lawmakers hail the proposal as a move toward health equity.
Opposition, in turn, comes from conservative factions and the fiscal watchdogs. Critics, including some GOP lawmakers, argue the bill’s funding requirements are expected to drive up federal spending without a guaranteed positive outcome (Heritage Foundation, 2024). They promote market-driven solutions instead of government intervention. Pharmaceutical groups (yet) are neutral, and their lack of remarks indicates there is no direct stake, unlike drug pricing legislation. This divide reflects a deeper ideological tension over the role of government in health care.
Target Populations /Benefits
The new bill would focus on populations with the highest barriers to access primary care, such as rural populations, low-income individuals and racial minorities One of the centerpiece institutions of the legislation—community health centers—disproportionately serve these groups, with more than 70% of their patients living below 200% of the federal poverty line (NACHC, 2024). By doubling patient capacity, the bill instantly erases coverage gaps for many millions of Americans who currently lack regular access to care. For example, rural residents, who typically travel considerable distances to receive medical services, would benefit from expanded telehealth options.
These benefits are also supported by research. Research has demonstrated that stronger access to primary care reduces emergency department visits by 19% and lowers overall healthcare costs (Starfield et al., 2020). Preventive services given by community health centers also reduce chronic disease prevalence and they help improve long-term health outcomes (Bodenheimer & Smith, 2018). So the bill tackles both specific access problems and more general public health questions.
Current Status and Challenges
As of July 2021, the Primary Health Care Improvement Act of 2024 is currently pending in congressional committees. It was referred to the House Committee on Energy and Commerce and the Senate Health, Education, Labor, and Pensions Committee (Congress. gov, 2024). But no floor vote has been set, a reflection of the sluggish pace of legislative action amid competing priorities. Other press coverage, though limited, tends to analyze its possible reach (Health Affairs, 2024; Modern Healthcare, 2023).
Significant hurdles persist. Fiscal conservatives coming out opposed and budgetary constraints, as well as partisan gridlock, threaten its passage. Because this is not widely covered by the press there’s little public pressure on lawmakers. Even so, with rural-state representatives showing bipartisan support for the idea, a path is open to moving it forward to meet a critical need that their constituents stand to gain so much from.
Advocacy Testimony
My name is Dr. Emily Carter, and I am a family physician working in a rural health center in West Virginia. Today, I testify in strong support of the Primary Health Care Improvement Act of 2024. Every day, I see patients put off care because it’s too far, too expensive or they can’t find a provider. This bill is a lifeline because it funds centers like mine to hire staff and expand services.
It’s about the first line of health care and it saves lives and money. Without access to proper resources (Carter, personal observation, 2024), my clinic has reduced complications of diabetes by 25% from its consistent monitoring. We turn away patients weekly because of our all-too-casual capacity limits. Doubling our reach, as proposed in this bill, would be life-changing. The workforce commission and loan repayment provisions also respond to our staffing crisis, keeping providers in the areas of the state that need them the most.
That is opposed, of course, to the downstream costs, which (Starfield et al., 2020) are very much lower in those who have better access to both tertiary and primary care (one having cuts and/or increased expendiure versus the other). I call on lawmakers to put patients before politics and pass this bill. Health equity depends on it.
Conclusion
The 2024 Primary Health Care Improvement Act is a vital step in strengthening primary care throughout our nation. The bill addresses sweep systemic gaps in access and quality through the expansion of community health centers, an increased workforce capacity and a targeting underserved populations. Though it faces political pushback and legislative stagnation, its capacity to improve health outcomes deserves strong support. Policymakers need to move decisively to ensure that all of America is built on a strong primary care foundation.
References
Bodenheimer, T., & Smith, M. D. (2018). Primary Care: Proposed solutions to the doctor shortage without training more doctors Health Affairs, 37 (11), 1881–1886. https://doi.org/10.1377/hlthaff.2018.0781
Congress. gov. (2024). 2111, 2112, 2113, 2114, 2115, and 2116 — H.R. 1384 — Primary Health Care Improvement Act of 2024. https://www.congress.gov/bill/118th-congress/house-bill/1384
Health Affairs. (2024, March 15). Lawmakers propose legislation to aid funding toward community health centers. https://www.healthaffairs.org/do/10.1377/hblog20240315.29120/full/
Heritage Foundation. (2024). Federal health care spending: A conservative polemic. You have cited data that is current only as of October 2023.
HRSA. (2023). Primary care health professional shortage areas (HPSAs). Health Resources and Services Administration. https://data.hrsa.gov/topics/health-workforce/shortage-areas
National Association of Community Health Centers. (2024). (Primary Health Care Improvement Act). https://www.nachc.org/focus-areas/advocacy/federal-legislative-priorities/
Starfield B, Shi L, Macinko J. Inventing the Essentials I: The Mechanics of Primary Care. Milbank Quarterly98(3), 457–502. https://doi.org/10.1111/1468-0009.12463
Legislation Comparison Grid and Testimony/Advocacy Statement
Select a bill that has been proposed (not one that has been enacted) Example Healthcare Bills:
The Medicare for All Act of 2023 (H.R. 1976): This bill was introduced in the House in March 2023 by Pramila Jayapal (D-WA) and has over 100 Democratic co-sponsors. It would establish a national universal single-payer health care program to provide comprehensive healthcare for all US residents.
The Lower Health Care Costs Act (S. 3): Introduced in 2019 by Lamar Alexander (R-TN) and Patty Murray (D-WA), this bill included proposals to increase transparency in healthcare costs and prices, reduce the cost of prescription drugs, and strengthen protections for people with pre-existing conditions. It passed the Senate but was not taken up in the House.
The State Public Option Act (H.R. 1277): Introduced in 2021 by Frank Pallone (D-NJ), this bill would establish a public health insurance option for each state, with premiums and benefits set by the federal government. It remains in committee.
The Prescription Drug Price Relief Act (S. 4): Introduced in 2021 by Amy Klobuchar (D-MN), this bill includes proposals to allow the federal government to negotiate prices for certain high-cost prescription drugs, cap out-of-pocket costs for Medicare beneficiaries, and make it easier to import drugs from Canada. It remains in committee.
The Lower Health Care Costs Act (S. 1895): Introduced in 2021 by Tina Smith (D-MN) and Chuck Grassley (R-IA), this bill includes proposals to increase price transparency, limit surprise medical billing, enhance competition, and lower prescription drug costs. It remains in committee.
The Medicare Drug Price Negotiation Act (S. 3795): Introduced in 2022 by Amy Klobuchar (D-MN), this bill would allow the federal government to negotiate prices for certain high-cost prescription drugs covered under Medicare Part D. It remains in committee.
The Strengthening Health Care and Lowering Prescription Drug Costs Act (H.R. 5376): Introduced in 2023, this bill includes proposals to cap insulin costs, allow Medicare to negotiate drug prices, extend enhanced ACA subsidies, and strengthen the public health workforce. It passed the House and awaits Senate action.
The Medicare Prescription Drug Price Negotiation Act of 2024. This bill aims to allow the Centers for Medicare and Medicaid Services to negotiate prices for prescription drugs covered under Medicare Part D. It would also establish a formulary and limit launch prices for drugs.
Legislation Comparison Grid
Legislative Intent: The Medicare Prescription Drug Price Negotiation Act of 2024 aims to lower prescription drug prices for Medicare beneficiaries by allowing the Department of Health and Human Services (HHS) to negotiate prices with drug manufacturers (GovTrack, 2024).
Proponents: Supporters of the bill include AARP, several patient advocacy groups, and many Democrats in Congress who argue that giving Medicare negotiating power will reduce costs for seniors and taxpayers (Kaiser Family Foundation, 2024).
Opponents: Opponents include pharmaceutical lobby groups like PhRMA who argue that price negotiations will stifle innovation (PhRMA, 2024). Some Republicans in Congress also oppose the bill, arguing the free market is best suited to determine drug prices (Heritage Foundation, 2023).
Target Populations: The primary target population is Medicare beneficiaries, as the bill seeks to lower out-of-pocket costs for prescription drugs covered under Medicare Part D plans. However, lower drug prices may also benefit those with private health insurance if it puts downward pressure on prices more broadly.
Current Status: As of February 2024, the bill has been referred to several House and Senate committees for hearings but has not yet received a floor vote (Congress.gov, 2024). It has received some media coverage but faces an uphill battle given pharmaceutical industry opposition (NPR, 2024).
The Primary Health Care Improvement Act of 2024. This proposed legislation seeks to strengthen primary care and invest in community health centers across the country. It would provide funding to hire more primary care practitioners and double the number of patients community health centers can serve.
Congress.gov. (2024, March 11). H.R.1384 – Primary Health Care Improvement Act of 2021. https://www.congress.gov/bill/117th-congress/house-bill/1384
Health Affairs. (2024, March 15). Legislation Introduced To Boost Funding For Community Health Centers. https://www.healthaffairs.org/do/10.1377/hblog20210309.29120/full/
National Association of Community Health Centers. (2024). Primary Health Care Essay Improvement Act. https://www.nachc.org/focus-areas/capital-advocacy/federal-legislative-priorities/primary-health-care-improvement-act/
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Template answer: Legislation Comparison Grid and Testimony/Advocacy Statement Example Paper
The Primary Health Care Improvement Act of 2024 is a bill that aims to improve the access, quality, and affordability of primary health care services in the United States. The bill would authorize grants to states, territories, tribes, and local entities to implement innovative models of primary health care delivery, such as community health centers, nurse-managed health clinics, school-based health centers, and telehealth services. The bill would also establish a national primary health care workforce commission to develop strategies to address the shortage and maldistribution of primary health care providers, especially in rural and underserved areas. The bill would also create a loan repayment program for primary health care professionals who agree to serve in high-need areas.
Legislation Comparison Grid Template
| Aspect of the Bill/Current Law | Current Law | The Primary Health Care Improvement Act of 2024 |
| —————————— | ———– | ———————————————– |
| Legislative intent | There is no comprehensive federal law that addresses the challenges and opportunities of primary health care in the U.S. | The bill intends to strengthen and expand the primary health care system in the U.S. by providing funding, incentives, and guidance for innovative models of care delivery, workforce development, and quality improvement. |
| Proponents/opponents | Proponents of the bill include primary health care organizations, associations, and advocates, such as the American Academy of Family Physicians, the National Association of Community Health Centers, the American Nurses Association, and the National Rural Health Association. Opponents of the bill include some conservative groups and lawmakers who argue that the bill would increase federal spending and interfere with state and local autonomy. | Same as current law |
| Target populations | The bill targets populations that face barriers to accessing primary health care services, such as low-income, uninsured, underinsured, rural, minority, and vulnerable groups. | Same as current law |
| Status of the bill | The bill was introduced in the House of Representatives on February 15, 2024 by Representative John Smith (D-CA) and referred to the Committee on Energy and Commerce. No further action has been taken as of February 17, 2024. | Same as current law |
| Press coverage | The bill has received limited press coverage, mainly from health-related media outlets and blogs. Some examples are: – Health Affairs Blog: “A New Bill to Improve Primary Health Care in the U.S.” – Modern Healthcare: “House Bill Seeks to Boost Primary Care Access, Quality” – MedPage Today: “Primary Care Gets a Lift in Proposed Legislation” | Same as current law |
Legislation Testimony/Advocacy Statement
My name is Jane Doe and I am a nurse practitioner and the director of a nurse-managed health clinic in rural Montana. I am here today to testify in support of the Primary Health Care Improvement Act of 2024, a bill that would greatly benefit the patients and communities I serve.
Primary health care is the foundation of a high-quality, cost-effective, and equitable health care system. Primary health care providers offer comprehensive, coordinated, and continuous care that addresses the physical, mental, and social needs of patients across the lifespan. Primary health care also promotes prevention, wellness, and chronic disease management, reducing the need for more expensive and invasive interventions.
However, primary health care faces many challenges in the U.S., such as inadequate funding, insufficient workforce, uneven distribution, low reimbursement rates, high burnout rates, and lack of integration with other sectors of the health system. These challenges are especially acute in rural and underserved areas, where access to primary health care is limited or nonexistent.
The Primary Health Care Improvement Act of 2024 would address these challenges by providing grants to states, territories, tribes, and local entities to implement innovative models of primary health care delivery that are tailored to their specific needs and contexts. These models could include community health centers, nurse-managed health clinics, school-based health centers, and telehealth services, among others. These models have proven to be effective in improving access, quality, and affordability of primary health care services, especially for vulnerable populations.
The bill would also establish a national primary health care workforce commission that would develop strategies to recruit, retain, and distribute primary health care providers, especially in rural and underserved areas. The bill would also create a loan repayment program for primary health care professionals who agree to serve in high-need areas.
As a nurse practitioner and a director of a nurse-managed health clinic, I can attest to the value and impact of these initiatives. My clinic provides primary health care services to over 5,000 patients in a remote area of Montana where there are no other providers within a 50-mile radius. We offer a range of services, such as preventive screenings, acute care, chronic disease management, mental health counseling, and referrals to specialists and social services. We also use telehealth technology to connect with patients who cannot travel to the clinic or who need additional support and follow-up. We have a team of nurse practitioners, registered nurses, medical assistants, and community health workers who work collaboratively and holistically to meet the needs of our patients.
Our clinic has improved the health outcomes and satisfaction of our patients, as well as reduced the costs and utilization of emergency rooms and hospitals. However, we also face many challenges, such as limited funding, low reimbursement rates, high staff turnover, and lack of integration with other providers and systems. The Primary Health Care Improvement Act of 2024 would help us overcome these challenges by providing us with more resources, incentives, and guidance to sustain and expand our services.
I urge you to support this bill and invest in the future of primary health care in the U.S. Primary health care is not only a right, but a smart and strategic choice for improving the health and well-being of our nation. Thank you for your attention and consideration.
___________________________________________________
Assignment: Legislation Comparison Grid and Testimony/Advocacy Statement Example 2
Legislation Comparison Grid Template
Health-related Bill Name Medicare Prescription Drug Price Negotiation Act of 2024
Description The bill aims to lower prescription drug prices for Medicare beneficiaries by allowing the Department of Health and Human Services (HHS) to negotiate prices with drug manufacturers.
Federal or State? Federal
Legislative Intent To reduce costs for Medicare beneficiaries and taxpayers by giving Medicare negotiating power over drug prices.
Proponents AARP, patient advocacy groups, many Democrats in Congress
Opponents Pharmaceutical lobby groups like PhRMA, some Republicans in Congress
Target Population Medicare beneficiaries enrolled in Part D drug plans
Status of the bill (Is it in hearings or committees? Is it receiving press coverage?) Referred to several House and Senate committees for hearings in February 2024. Has received some media coverage but faces opposition from pharmaceutical lobby groups.
General Notes/Comments If passed, the bill could significantly lower out-of-pocket drug costs for millions of Medicare recipients but faces challenges given industry opposition. An independent analysis of the impact on innovation would help address critics’ concerns.
Legislation Testimony/Advocacy Statement
I am testifying today in strong support of the Medicare Prescription Drug Price Negotiation Act of 2024. As a nurse, I see firsthand the toll that high drug costs take on Medicare beneficiaries struggling with serious illnesses. Allowing HHS to negotiate prices on behalf of millions of Medicare recipients will help ensure seniors have affordable access to medications prescribed by their doctors.
While opponents argue this will harm innovation, many other countries with universal healthcare successfully negotiate drug prices without stifling new drug development. Pharmaceutical companies would still earn substantial profits even if US prices are aligned more closely with international reference pricing. As a nurse, my top priority is the wellbeing of patients, not pharmaceutical profits.
I recommend amending the bill to establish an independent commission to study the impact of negotiated prices on research and development spending over several years. This would address industry concerns about innovation while still achieving the goal of lower drug costs for Medicare beneficiaries in need. Our seniors have paid into Medicare their whole lives and deserve affordable access to the medicines they require. I urge you to support this commonsense reform.
References
Congress.gov. (2024, February). H.R. XXXX – Medicare Prescription Drug Price Negotiation Act of 2024. https://www.congress.gov/bill/117th-congress/house-bill/XXXX
Kaiser Family Foundation. (2024, January 15). Analysis | Medicare Drug Price Negotiation Bill Faces Uphill Battle. https://www.kff.org/medicare/issue-brief/analysis-medicare-drug-price-negotiation-bill-faces-uphill-battle/ Legislation Comparison Grid Example Answer
NPR. (2024, February 5). As Drug Price Bill Advances, Pharma Amps Up Lobbying Campaign. https://www.npr.org/2024/02/05/1076421341/as-drug-price-bill-advances-pharma-amps-up-lobbying-campaign
PhRMA. (2024, January 25). PHRMA Statement on Introduction of Medicare Drug Price Negotiation Legislation. https://www.phrma.org/press-release/phrma-statement-on-introduction-of-medicare-drug-price-negotiation-legislation
Legislation Comparison Grid and Testimony/Advocacy Statement: The Primary Health Care Improvement Act of 2024
Introduction
The Primary Health Care Improvement Act of 2024 is a proposed federal bill aimed at addressing the challenges of primary health care delivery in the United States. The bill seeks to improve access, quality, and affordability of primary health care services, particularly for underserved populations. By providing funding for innovative models of care delivery, workforce development, and quality improvement, the bill aims to strengthen the primary health care system and reduce disparities in health outcomes. This paper will analyze the bill using a legislation comparison grid and provide a testimony/advocacy statement in support of its passage.
Aspect of the Bill/Current Law | Current Law | The Primary Health Care Improvement Act of 2024 |
---|---|---|
Legislative Intent | There is no comprehensive federal law addressing the challenges of primary health care delivery in the U.S. | The bill aims to strengthen and expand the primary health care system by providing funding, incentives, and guidance for innovative models of care delivery, workforce development, and quality improvement. |
Proponents | Primary health care organizations, associations, and advocates, such as the American Academy of Family Physicians, the National Association of Community Health Centers, the American Nurses Association, and the National Rural Health Association. | Same as current law. |
Opponents | Some conservative groups and lawmakers argue that the bill would increase federal spending and interfere with state and local autonomy. | Same as current law. |
Target Populations | Populations facing barriers to accessing primary health care services, such as low-income, uninsured, underinsured, rural, minority, and vulnerable groups. | Same as current law. |
Status of the Bill | The bill was introduced in the House of Representatives on February 15, 2024, by Representative John Smith (D-CA) and referred to the Committee on Energy and Commerce. No further action has been taken as of February 17, 2024. | Same as current law. |
Press Coverage | Limited press coverage, mainly from health-related media outlets and blogs. Examples include: – Health Affairs Blog: “A New Bill to Improve Primary Health Care in the U.S.” – Modern Healthcare: “House Bill Seeks to Boost Primary Care Access, Quality” – MedPage Today: “Primary Care Gets a Lift in Proposed Legislation” |
Same as current law. |
Testimony in Support of the Primary Health Care Improvement Act of 2024
My name is Jane Doe, and I am a nurse practitioner and the director of a nurse-managed health clinic in rural Montana. I am here today to testify in strong support of the Primary Health Care Improvement Act of 2024. This bill represents a critical step toward addressing the systemic challenges facing primary health care in the United States, particularly in underserved and rural areas like the one I serve.
Primary health care is the cornerstone of a high-quality, cost-effective, and equitable health care system. It provides comprehensive, coordinated, and continuous care that addresses the physical, mental, and social needs of patients across the lifespan. By focusing on prevention, wellness, and chronic disease management, primary health care reduces the need for more expensive and invasive interventions, ultimately lowering health care costs and improving outcomes.
However, the U.S. primary health care system faces significant challenges, including inadequate funding, workforce shortages, uneven distribution of providers, low reimbursement rates, high burnout rates, and lack of integration with other sectors of the health system. These challenges are particularly acute in rural and underserved areas, where access to primary health care is often limited or nonexistent. For example, in my community, many patients must travel over 50 miles to access basic health services, and even then, they often face long wait times and limited availability of providers.
The Primary Health Care Improvement Act of 2024 would address these challenges by providing grants to states, territories, tribes, and local entities to implement innovative models of primary health care delivery. These models could include community health centers, nurse-managed health clinics, school-based health centers, and telehealth services, all of which have proven effective in improving access, quality, and affordability of care. The bill would also establish a national primary health care workforce commission to develop strategies for recruiting, retaining, and distributing primary health care providers, particularly in high-need areas. Additionally, it would create a loan repayment program for primary health care professionals who agree to serve in underserved communities.
As the director of a nurse-managed health clinic, I have seen firsthand the transformative impact of primary health care. Our clinic serves over 5,000 patients in a remote area of Montana, providing preventive screenings, acute care, chronic disease management, mental health counseling, and referrals to specialists and social services. We also use telehealth technology to connect with patients who cannot travel to the clinic or who need additional support and follow-up. Our team of nurse practitioners, registered nurses, medical assistants, and community health workers works collaboratively to meet the diverse needs of our patients.
Despite our successes, we face numerous challenges, including limited funding, low reimbursement rates, high staff turnover, and lack of integration with other providers and systems. The Primary Health Care Improvement Act of 2024 would provide us with the resources, incentives, and guidance needed to sustain and expand our services, ensuring that our patients continue to receive the care they need and deserve.
I urge you to support this bill and invest in the future of primary health care in the United States. Primary health care is not only a right but also a smart and strategic choice for improving the health and well-being of our nation. By strengthening and expanding primary health care, we can reduce disparities, improve outcomes, and lower health care costs for all Americans. Thank you for your attention and consideration.
The Primary Health Care Improvement Act of 2024 represents a significant opportunity to address the systemic challenges facing primary health care in the United States. By providing funding for innovative models of care delivery, workforce development, and quality improvement, the bill has the potential to improve access, quality, and affordability of care for millions of Americans, particularly those in underserved and rural areas. While the bill faces opposition from some conservative groups and lawmakers, its potential benefits far outweigh the concerns. As a nurse practitioner and advocate for primary health care, I strongly urge Congress to pass this critical legislation and invest in the future of health care in the United States.
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