Letters: Primary care is undervalued by insurance companies. This threatens the health of our communities.
As a family physician practicing in Illinois, I have witnessed firsthand the growing challenges facing primary care providers. Despite being the cornerstone of our healthcare system, primary care is increasingly undervalued, leading to a silent crisis that threatens the health of our communities.
Insurance companies are increasingly employing algorithms to downcode evaluation and management (E/M) services, often without thorough chart reviews. This practice reduces reimbursement for primary care services, undermining the financial viability of independent practices.
The result is a healthcare landscape where primary care physicians are disincentivized, leading to decreased access for patients and higher long-term costs due to preventable hospitalizations and emergency care.
Moreover, the consolidation of healthcare systems has created monopolistic entities that prioritize high-revenue specialties over primary care. This shift not only inflates healthcare costs but also diminishes patient choice and continuity of care. The market's failure to appropriately value primary care services contradicts the principles of efficient resource allocation and consumer welfare.
To rectify this, policymakers and insurers must recalibrate reimbursement models to reflect the true value of primary care. Emphasizing preventive care and chronic disease management can lead to substantial cost savings and improved patient outcomes. Additionally, fostering competition by supporting independent practices can enhance service quality and accessibility.
The economic rationale is clear: investing in primary care is not just a moral imperative but a fiscal necessity. Addressing this market failure is essential for creating a sustainable and equitable healthcare system.These uncertain times have left many on edge, both in Washington, D.C., and Springfield. We urge Illinois lawmakers to take a cautious approach when legislating health coverage mandates, particularly given the challenges ahead with the still-developing congressional budget proposal. A healthy, competitive market benefits consumers by providing more choices and lowering costs. This is especially crucial as Illinois works to establish its own health insurance marketplace.
As a result, Illinois Life & Health Insurance Council (ILHIC) is deeply concerned about the congressional budget proposal taking shape in Washington, D.C., and its devastating impact on public and private health insurance in Illinois. The loss of enhanced premium tax credits coupled with the potential rollback of Medicaid expansion could further lead to widespread coverage losses. According to a preliminary review of the proposed federal budget by the Congressional Budget Office, more than 13 million Americans are at risk of being further priced out of private health insurance or losing their Medicaid coverage, including up to 800,000 or more Illinoisans.
We cannot afford to jeopardize the health and well-being of more than three-quarters of a million Illinois residents.
Even in Illinois, vigilance is key. The Healthcare Protection Act expansion proposal, now House Bill 3019, initially included an 87% Medical Loss Ratio for private market insurers — a change that threatened to further disrupt the state individual and small-group insurance market. Illinois is already facing the exit of two insurers from the individual market in 2026 — Health Alliance and Aetna — and four insurers have already left or will leave the small group market by next year.
Fortunately, ILHIC's discussions with Gov. JB Pritzker's office and the Illinois Department of Insurance have yielded results – the 87% MLR provision in the bill has been removed. We appreciate the governor's commitment to engaging stakeholders and addressing concerns about the future of the state's health insurance market.
As the state's leading advocate for a strong and sustainable health insurance industry, ILHIC will continue working in good faith with the governor's office and the Illinois Department of Insurance as a reliable partner dedicated to ensuring that Illinois residents continue to have access to affordable, high-quality health care and life insurance.I have a lot of respect for the Rev. Michael Pfleger and what he is doing. Sixty-two years ago, I was a caseworker in a district that included part of Orleans St. Talking to a landlord, who was not your typical slumlord, I realized that the kids in the area had no summer activities, unlike the kids in the areas we lived in. The outcome of that conversation was that we and the two priests at the neighborhood Catholic church started a youth group. The mayor's commission on youth welfare got involved later, so I understand what Pfleger is trying to do. He can't do it alone and I understand his anguish and frustration over the shooting that happened Saturday. ('This is personal': 7 teens wounded in drive-by shooting in Auburn Gresham after St. Sabina graduation party', June 1)
These are my suggestions for what can be done by the legislature, educators, physicians, families, neighbors, and social media influencers:
Maybe if everybody pulls together this senseless violence can stop.While I concur with the sentiment of Edward Keegan's column proposing a park at the Lincoln Yards site, I feel a well-regulated campground with modest fees and well-maintained water and bathing facilities — comparable to the fieldhouse at Rosedale Park — and with respectful security, would ultimately stabilize Chicago's housing infrastructure. ('Chicago should turn Lincoln Yards development into a public park', June 1) It would also improve access to the city for seasonal employment, alleviate the effects of the housing shortage and enrich the city's cultural experience as campers participate in the city's not-inconsiderable summer economy in a way far superior to a park without such amenities. This use would limit the environmental impact of the development and provide a focus on natural and official co-living spaces within the city limits. I am also not aware of a development like this in another major city. Cook County has had such a campground in or near Orland Park. It was beautiful last time I visited. We have many examples of the civic successes of such campsites, with the most obvious being the national parks — which could serve as a model for such a campground. There could be cabins and a general store featuring local produce and goods.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Associated Press
38 minutes ago
- Associated Press
New online tool helps women on Medicaid find prenatal care and family planning
At the University of Mississippi Medical Center, one researcher's full-time job for the past nine months has been to find out which clinics around the state offer different kinds of women's health care, and whether they accept various forms of Medicaid. The final result is a recently launched database aimed at helping women locate the nearest clinic that can offer the care they need. The work that went into creating it highlights a pervasive problem: Even making an appointment can be a barrier that keeps women from improving their lives. 'We Need to Talk' is a compilation of all Mississippi clinics offering prenatal care – specifying which ones also offer family planning, and whether they take Medicaid insurance, Medicaid waivers and see women whose Medicaid applications are pending. There is also a hotline designed to give additional support to anyone having questions or feeling overwhelmed about the process. 'Having gone through the work, it was remarkable. It wasn't easy to figure out where you should go for care,' said Dr. Thomas Dobbs, former state health officer and dean of the John D. Bower School of Population Health at UMMC, who oversaw the project. 'And that should be one of the most basic bits of information we have.' The idea was born from the recent 900% increase in babies born with syphilis, Dobbs explained, which he called a 'canary in a coal mine' signaling more danger to come. An investigation into the epidemic showed that one of the driving factors was delayed prenatal care, caused in large part by inaccessible information and concerns about cost, Dobbs said. Finding reproductive and prenatal care can be difficult for several reasons. For one thing, there are many different kinds of clinics in Mississippi, making it hard for patients to know what to search for. The list includes federally qualified health centers, county health department clinics and private OB-GYNs. Another reason is that many clinics don't specify online whether they take Medicaid, much less what their policy is on specific or temporary Medicaid coverage. Calling doesn't always guarantee patients a comprehensive or accurate answer. The new database is an initiative of UMMC's Myrlie Evers-Williams Institute – housed in the Jackson Medical Mall – which is committed to eliminating health disparities by studying the intersection of health and social issues. The institute has a clinic on site that practices what's called 'social medicine,' a key element of eliminating those disparities, the institute's executive director Victoria Gholar explained. 'If you have a patient who has asthma and they're living in a situation where mold is in their environment, it will really be hard for them to get better,' Gholar said. 'Or, if we have a patient who has to use an electronic (medical) device, and their electricity is no longer available because they weren't able to take care of their utility bill, then we try to work with them and connect them to resources that might be able to help.' The institute employs a wide range of professionals who work on health from a non-clinical standpoint, such as researchers, community engagers, social workers and registered dietitians. It hosts events like food drives and offers free support from budgeting strategies to meal preparation for those with conditions like diabetes or high blood pressure. Aside from knowing what to search for, finding clinics that accept Medicaid can also be complicated because Mississippi Medicaid eligibility is constantly changing for a woman based on her age and circumstance – what kinds of services she's seeking, as well as whether she's pregnant. Medicaid eligibility in Mississippi is among the strictest in the nation, with one exception – pregnant women. That means many low-income women only become eligible for Medicaid once pregnant. And since an application can take up to eight weeks to be processed, the chances that a woman in this situation will be able to use her newly acquired Medicaid insurance in the first trimester are slim. A law that would cut out this interim period and allow low-income pregnant women to be immediately seen by a doctor passed the Legislature in 2024, but was never implemented because of legislative errors. The policy went back through the Legislature in 2025, passed overwhelmingly again, but is not yet in effect. Some doctors already see women whose Medicaid application is pending, and the UMMC tool specifies at which clinics that's the case. Women of reproductive age seeking reproductive health care are also eligible for leniency in the typical Medicaid stipulations. These women can apply for a Medicaid family planning waiver, which allows them to access Medicaid for family planning purposes, even if they don't qualify for general Medicaid coverage. The income requirement for pregnancy Medicaid and the family planning waiver is a household income of less than 194% of the federal poverty level, or about $2,500 a month for one person in 2025. Dobbs, who has been the main point person on the project, said he hopes the online database is one more resource improving health care accessibility and women's health metrics in Mississippi. 'This isn't about getting patients to UMMC at all,' Dobbs said. 'It's about empowering patients to be able to get the care they need where they live.' ___ This story was originally published by Mississippi Today and distributed through a partnership with The Associated Press.
Yahoo
an hour ago
- Yahoo
Rep. Don Scott to discuss threats to Medicaid in Norfolk
NORFOLK, Va. (WAVY) — Virginia House Speaker Don Scott will join other advocates for reproductive freedom in Norfolk on Friday to speak about the threat to Medicaid. The stop at the Slover Library is the final stop of a statewide tour called 'Protect our Medicaid.' The goal of the tour, according to a release, is to raise awareness of the threat cuts to Medicaid could have on Virginia families. Those with the Protect our Medicaid group said the federal cuts to Medicaid under the Trump Administration's 'Big, Beautiful Bill' could cause over 250,000 Virginians to lose their healthcare, with nearly 47,000 veterans alone in the state covered by Medicaid. The bill includes a proposed $625 million cut in Medicaid — which could cause 7.6 million people nationwide to lose health coverage in less than a decade, according to budget analysis. A release from the group states that Medicaid is the largest source of funding for home care in the United States, with home care for older adults and people with disabilities rising across the country. GOP bill raises fears of major reduction in home care for seniors, disabled The discussion will address how cuts to both Medicaid and Planned Parenthood can impact the Hampton Roads regional economy and how it will harm Virginia families. The Protect our Medicaid tour is expected to be held in the third floor at the Slover Library starting at 11 a.m. Continue to check for updates. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Yahoo
2 hours ago
- Yahoo
4 in 10 Republicans worried Medicaid cuts would hurt their communities: poll
At least 4 in 10 Republicans are worried about the consequences of Medicaid cuts on their families and communities, according to a new survey. The KFF poll, released Friday, found a partisan divide in the level of concern. Still, about 40 percent of Republicans said they were concerned Medicaid cuts would lead to more adults and children becoming uninsured and negatively impact hospitals, nursing homes and other health care providers in their communities. The findings also show how politically fraught Medicaid is and the dangers for Republicans who are seeking to cut billions of dollars from the program to pay for President Trump's domestic policy agenda. The House-passed legislation would cut nearly $800 billion from Medicaid, primarily by requiring childless adults up to age 64 to prove they are working, going to school or volunteering for 80 hours a month. It also puts a freeze on provider taxes, a practice used by many states to get increased federal reimbursement that often goes towards paying for Medicaid. The politics of the health insurance program for low-income Americans are changing, and Republicans now risk alienating their own voters. Lower-income, working-class people who rely on Medicaid are now a major part of the GOP base, which has become more populist since the emergence of Trump. While most Medicaid beneficiaries under age 65 are either Democrats or independent, 27 percent said they are Republicans or lean Republican, including 19 percent who identify as Trump's MAGA supporters, according to KFF. Among those GOP Medicaid recipients, the poll found three-quarters are worried that sweeping changes to the program would hurt their family's ability to get and pay for care, and nearly 70 percent are concerned the cuts would lead to an increase in the uninsured and negatively impact providers. Overall, Democrats and independents said they were much more likely than Republicans to worry about potential negative consequences of Medicaid cuts. But nearly a third of Republicans and 26 percent of MAGA supporters who aren't on Medicaid said they were concerned about their or their families' own access to health care, the survey found. Medicaid is also key to keeping many rural providers from closing. In Missouri for instance, which was the most recent state to expand the health program, industry experts said about 10 rural hospitals closed in the years leading up to the expansion vote. Ever since, there haven't been any closures. Overall, about seven in ten rural residents said they were worried Medicaid cuts would lead to more adults and children becoming uninsured, or that it would negatively impact health care providers in their communities, according to the poll. Nearly half of rural Republican respondents said they were worried about providers, while 37 percent of rural Republicans said they were worried Medicaid cuts could affect their access to care. According to the Congressional Budget Office, 7.8 million people could lose Medicaid coverage and become uninsured over the next decade. The survey was conducted May 5-26 among 2,539 U.S. adults. The margin of error was plus or minus 3 percentage points. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
