Washington—On behalf of the more than 560,000 physicians and medical students represented by the combined memberships of our organizations, we strongly urge the Centers for Medicare and Medicaid Services (CMS) to put patients first, and reconsider its willingness to approve state waiver requests that would impose work requirements as a condition of Medicaid eligibility. Our members are the frontline physicians who care for patients in rural, urban, wealthy and low-income communities, and are the foundation of the American health care system. These measures would be punitive and detrimental to patient care.
Our organizations issued joint principles on this issue, which we shared with Acting HHS Secretary Hargan and CMS Administrator Verma on December 8, 2017, letter. These principles urge CMS to “do no harm” when evaluating and approving waiver proposals from states, and include the following recommendation:
Limiting Barriers to Eligibility and Coverage: CMS should ensure that waivers and other proposed changes to Medicaid do not impose punitive requirements that individuals be employed, be actively seeking a job, or be enrolled in a job training or job recruitment program and/or impose mandatory drug testing as a condition of eligibility.
- Imposing work requirements, lock-outs, premiums, and other out-of-pocket costs will limit access to preventive and primary care services and inhibit Medicaid beneficiaries from seeking care that helps them avoid costlier health conditions and maintain wellness. While we support voluntary programs to assist Medicaid enrollees in obtaining a job or gaining job skills, as well as voluntary access to treatment for substance use disorders, we are concerned that making participation in such programs a mandatory condition of eligibility would create unacceptable barriers to care, especially for the most vulnerable persons.
The Medicaid program was created to ensure access to needed care. CMS’ effort encourages rules designed to prevent low-income individuals from getting the care they need and is contrary to the program’s mission. The loss of health care coverage under this policy will only increase health care system costs and contribute to poor health, including premature mortality and increased morbidity.1
We strongly urge CMS to pursue policies that put patients first. We welcome the opportunity to work with the agency to develop policies that will help ensure the health of our nation.
1Woolhandler S, Himmelstein DU. The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?. Ann Intern Med. 2017;167:424–431. doi: 10.7326/M17-1403. Accessed 12 January 2018 at http://annals.org/aim/fullarticle/2635326/relationship-health-insurance-mortality-lack-insurance-deadly
About the American Academy of Family Physicians
Founded in 1947, the AAFP represents 129,000 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.
Family physicians conduct approximately one in five office visits—that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.
To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website, www.familydoctor.org.
About the American Academy of Pediatrics
The American Academy of Pediatrics is an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds.
About the American College of Obstetricians and Gynecologists
The American College of Obstetricians and Gynecologists (ACOG), is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. www.acog.org
About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 152,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.
About the American Osteopathic Association
The American Osteopathic Association (AOA) represents more than 129,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools. Visit DoctorsThatDO.org to learn more about osteopathic medicine.
About the American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 37,000 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.