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America can get healthier if we make the right choices


Marc Hackett runs the Jane Pauley Community Health Center in central Indiana; they operate 12 sites in four counties. Since COVID hit the U.S., they’ve experienced a doubling in the number of patients who need behavioral health services. 

Hackett, who works closely with Jane Pauley, the clinic’s namesake and a popular TV journalist, is proud that their community health center serves both Hoosiers’ medical and mental health needs. Indeed, Pauley herself has written and talked about her own journey with bipolar disorder. 

Yet the recent influx of patients, especially teenagers, coping with depression and suicide ideation can feel overwhelming.

Even before the pandemic, life expectancies were diverging across communities. Early deaths from opioid misuse, smoking, a host of chronic diseases, isolation and loneliness were afflicting communities with lower-income neighborhoods hit particularly hard. 

President Joe Biden’s 2023 budget appropriately recognizes the mental health crisis affecting our country but, working together, the administration and Congress will need to go further.   

The administration’s spending plan proposes covering three behavioral health visits in Medicare with no cost-sharing and takes other steps to modernize Medicare benefits, such as covering the support of community health workers. For patients with private insurance, cost-sharing would be eliminated for three primary care and three behavioral health visits each year, encouraging prevention and early treatment, regardless of insurance.

An important next step is truly integrating behavioral health into the care offered by community health centers, primary care doctors, nurse practitioners and other professionals. This is critical because primary care is where most patients first seek and obtain mental health services, but it will take more investment. 

Tragically, we underinvest in primary care, with studies showing only 5 percent of total U.S. health care spending is dedicated to what is the foundation of good health.

Study after study shows that when primary care is well-resourced and people have an ongoing source of primary care, we get better, more holistic health and fewer unnecessary trips to emergency department. 

Primary care practitioners focus on prevention, early diagnosis of problems and ongoing monitoring of health. Primary care can connect people to community resources to prevent hardship or isolation from affecting health. Primary care is also good for public health. Over 80 percent of adults surveyed said they had a great deal or a fair amount of trust in their own doctor and their child’s pediatrician, more than any other source of information about COVID-19 vaccines.  

A recent landmark study from the National Academies of Sciences, Engineering, and Medicine found that if more people and communities had access to high-quality primary care, our population would be healthier and health disparities across geography, race, income and other factors would narrow.  

Members of Congress from both sides of the aisle can boost Biden’s proposed budget by not only investing more in primary care but also paying primary care upfront, so they can hire teams, be proactive and provide more preventive care. We know from models in Medicare and the private sector that this approach works.

Right now, at best, progress has been uneven, some states such as Rhode Island and Connecticut are already making great progress in building up primary care, ensuring it includes behavioral health and other key services. In other states, like Indiana, there are hurdles. As we emerge from the pandemic, Congress can make a difference by fully embracing and supporting every part of primary care and all the benefits to patients that such a decision would bring.

Ann Greiner is president and CEO of Primary Care Collaborative and Frederick Isasi is Executive Director of Families USA.

Tags budget Joe Biden

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