George D. Lundberg, MD
We all know that primary care is critical to the health of Americans and the stability of the entire healthcare system. We also know that American primary care is chronically troubled: underfunded, understaffed, underpaid, unavailable, underappreciated, underrecognized, and poorly distributed. The situation is only getting worse — collapsing under its own weight.
In a rare display of bipartisanship, the US House of Representatives passed the Medicaid Primary Care Improvement Act (MPCIA) by voice vote of the 118th Congress. Although the Senate failed to act during the previous session, the bill’s reintroduction to the 119th Congress represents a potential shift toward a more sustainable and physician-centered healthcare model.
This Act offers one of the few realistic paths to stabilizing the system. So far this term, the Senate has been blocked by partisanship. It should pass this bill and give the President a big win in a politically fraught situation, what with the anticipated harms of H.R. 1, or the so-called One Big Beautiful Bill Act.
How the MPCIA Addresses Practice Pain Points
This observer is frankly surprised by how uniquely valuable this bill could be for primary care physicians, especially as one fifth of all Americans are covered by Medicaid. The bill features:
- State-regulated capitated payments for primary care, giving practices predictable and stable revenue instead of the unstable fee-for-service churn
- No involvement of for-profit health insurers, eliminating the layers of middlemen who currently extract resources without delivering care
- Minimized administrative burden, with simplified reporting requirements and a structure designed to free clinicians from the endless documentation and prior-authorization cycles
- Flexibility for states to design primary care models that fit their populations, rather than one-size-fits-all federal mandates
- Support for integrated, team-based care, allowing practices to use capitated funds to hire behavioral health services, care coordinators, and other essential staff
- A more sustainable path for Medicaid, turning it from a financial strain into a stabilizing force for primary care practices
These features directly address the pain points that physicians have been raising for years.
The Obstacles Ahead
However, there are a few remaining areas that may work against the bill politically. These include concerns about shifting from fee‑for‑service to capitated models, misunderstanding about state‑regulated payment systems, resistance from stakeholders who benefit from the current insurer‑driven structure, and legislative bandwidth being consumed by the rollout of the One Big Beautiful Bill Act.
The Bipartisan Case for Reform
I am no politician, but it seems to me to be politically smart to get the President’s signature on this bill as fast as the Congressional process allows it to move.
It removes for-profit insurers from the primary care payment stream, appealing to voters frustrated with corporate influence in healthcare.
It offers a practical, physician-centered counterbalance to the expected disruptions of the One Big Beautiful Bill Act.
It supports rural communities, which are disproportionately harmed by primary care shortages and overwhelmingly represented by Republican lawmakers.
It demonstrates proactive leadership on healthcare stability rather than reactive criticism.
It aligns with fiscal conservatism because capitated primary care reduces downstream spending and avoids insurer overhead.
What’s not to like?
A Call to Action
For the primary care workforce, this bill is not theoretical. It’s a chance to practice medicine without drowning in paperwork, without insurer interference, and with predictable revenue that supports real patient care. The Senate’s decision will determine whether primary care continues to erode or finally gets the structural support it needs.
I do hope that our American Medical Association (AMA), along with the involved specialty societies, provides strong lobbying support for this bill on behalf of the health of the public and the viability of primary care. This, despite the fact that MPCIA introduces capitated payments for services with no Current Procedural Terminology coding, resource-based relative value scale use, or special considerations for procedure-based care.
We loyal AMA members are watching you.
