I Told Lawmakers Why My Patients Need Strong Support for Medicaid

The conversation around Medicaid is about to get loud, contentious and complicated, but my message when I testified on Capitol Hill Feb. 12 was simple and spoke a truth familiar to family physicians nationwide.

I was pleased to represent the AAFP at that day’s Senate Special Committee on Aging hearing, “Optimizing Longevity: From Research to Action.” At the core of what I told the committee was this: “If we want to truly improve our nation’s health to optimize longevity, it must start with investing in Medicaid and other safety-net supports — not cutting them.”

Centering my testimony on Medicaid was timely and strategic. The hearing was convened just as House Republicans were setting out a budget resolution that would slash as much as $2 trillion from Medicaid. The White House has said Medicare is safe from cuts — which puts the bull’s-eye on Medicaid.

The Academy is already moving on this issue (and urging members to speak out), and we know that defending Medicaid is important to our peers in the house of medicine as well as to the public. Polling this month shows that nearly 80% of Americans, across party lines, do not support cuts to Medicaid.

As I told the committee, this is personal for me as a family physician in the South Bronx, and someone focused on caring for marginalized communities and the uninsured.

“I always knew I wanted to be a doctor, and my journey to family medicine started as a grade-schooler in the 1980s, when I was troubled witnessing unhoused individuals — disproportionately veterans — sleeping on sidewalks and street grates in the very heart of our nation’s capital,” I said, recalling my childhood in Washington, D.C. “I felt called to serve them but was not sure how. My mother, a social worker, told me that I could grow up to become the kind doctor who takes care of them. And so, I set my life’s course to do just that.”

I told the committee: I’m proud to be a family physician — delivering continuous, comprehensive medical care, health maintenance and education, and preventive services to patients across their entire lifespan. I have done this work for more than two decades in an extremely under-resourced area of the South Bronx, where my patient panel approaches nearly 90% Medicaid beneficiaries.

My Medicaid patients, as is the case for so many around the country, face challenges meeting health-related social needs. Some lack safe, stable housing or reliable transportation. For others, financial security is unheard of. Access to nutritious foods is often limited. All of that before we even talk about whether and how they get necessary medications and keep their appointments to see me.

A hearing dedicated to increasing longevity was a good place to point out the ways that unaddressed health-related social needs across the lifespan can bring on or worsen many health conditions, including chronic diseases.

“On more than one occasion, when I asked a patient why they were not taking their insulin as directed, I would find out they did not have electricity in their apartment for weeks at a time after falling behind on the rent,” I testified. “A neighbor was allowing them to store their medications that require refrigeration, but that also meant they did not have it readily accessible.”

At least I had the opportunity to hear their story — that patient made it in to see me. Medicaid cuts would effectively cut off patients from care, including some of the most vulnerable.

“Medicaid serves a critical need, providing coverage for patients and sustaining community health centers delivering care to these struggling communities,” I told the committee. “Those same Medicaid beneficiaries with diet-related conditions experience higher levels of food insecurity. One study found that nearly one-third of Medicaid enrollees with diabetes were food insecure, compared with 7 percent of those enrolled in private insurance.”

I told the committee that the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program is a lifeline for my food-insecure patients. SNAP, too, is being targeted for severe budget cuts. There was plenty of talk during the hearing about nutritious food and exercise as tickets to longevity. Without robust Medicaid and SNAP funding, better health will remain out of reach for countless patients.

As I testified, “Food and exercise can only be medicine if they are equitably and easily available, safe and accessible. As a family physician, I can recommend working out and having a healthy diet — but it is up to you, our elected leaders, to ensure the resources and support are in place to fill that prescription.”

Many of my patients are eligible for both Medicaid and Medicare. Congress has opportunities to improve the latter program, I told the committee.

“The AAFP has supported legislation that would expand Medicare coverage of nutrition services for seniors with certain diet-impacted chronic conditions, such as diabetes, HIV and hypertension,” I testified. “We have also supported legislation that would establish a four-year nationwide demonstration program through Medicare to provide medically tailored meals to eligible Medicare beneficiaries with diet-impacted conditions. I strongly encourage the committee to consider these policies as you continue to explore opportunities to improve health across the lifespan.”

I also reminded the committee that patient cost-sharing requirements limit uptake by patients who would truly benefit from this type of additional support. While cost-sharing for most preventive services is waived across payers, many patients find the system complex and do not access all the preventive care recommended for them because they do not know what is covered and fear being billed for what might not be covered. A 2022 study found that Medicare billing codes for preventive medicine and care management services are being underused, even though primary care physicians were providing code-appropriate services to many patients.

This is why the AAFP continues to urge Congress to pass legislation that would waive patient cost-sharing for chronic care management and other primary care services. We believe this will increase access without increasing overall health care spending.

Again, this is about investing in the nation’s health. If lawmakers want to optimize longevity, they must ensure that Medicaid, SNAP, Medicare and related safety-net programs are adequately funded and accessible. Much of our safety net is built on the foundation of a robust network of community health centers, in counties and districts across our rural, suburban and urban communities. Anything but an investment in Medicaid destabilizes this very foundation: Medicaid is the primary payer for almost 50% of services provided at community health centers. In addition, our nation’s most successful endeavor in training primary care physicians and keeping them in the communities that need them has been the Teaching Health Center Graduate Medical Education program, reliant on those CHC homes.  

Preserving Medicaid is going to be a fight. The AAFP is determined to lead that fight. All of us who serve Medicaid patients know what’s at stake. I testified with my patients in mind. I encourage you to contact your members of Congress and attest to your own experiences.