Fourteen million individuals were added to the Medicaid and Children’s Health Insurance Program (CHIP) rolls during the COVID-19 public health emergency, with total enrollment reaching 85 million by September 2021. Most will remain eligible when the Biden administration declares the public health emergency is over. But just because you have a plastic card in your pocket doesn’t mean you have access to health care.

A report by analysts at the Medicaid and CHIP Payment Access Commission (MACPAC) finds only about two-thirds of primary care physicians are accepting new Medicaid patients. And wait times for appointments can still be difficult even among providers who accept new Medicaid patients. Medicaid payment rates play a major role in providers’ decisions to accept new Medicaid patients. A new study suggests bureaucratic hassles obstructing prompt payment are also a factor. Sometimes those long waits for appointments might be due to providers stealthily placing quotas on the number of Medicaid patients they can afford to see per month.

A new proposal that might help mitigate the difficulties Medicaid and CHIP patients face when trying to get in to see a primary care practitioner seeks to incentivize Direct Primary Care (DPC) as well as conventional primary care practitioners render care to such patients pro bono. DPC providers rarely accept any form insurance, especially Medicaid or CHIP. They offer patients the full range of primary care services in return for a flat, recurring retainer fee.

Last May, Rep. Daniel Webster (R‑FL) introduced H.R. 7831, “Helping Everyone Access Long Term Healthcare” (HEALTH) Act. The proposal would allow DPC providers to deduct from their income taxes covered charity services they provide to patients enrolled in Medicaid or CHIP patients, provided that they don’t seek or expect to receive any payment from those programs based upon their published fees for such services. It would allow conventional primary care practitioners—who work on a fee-for-service basis—to deduct “the unreimbursed Medicare-based value of qualified charity care.”

The proposal is worth considering. As a surgeon who treats cancer patients, I often have a tough time getting prompt appointments with needed specialists for my postop patients who are on Medicaid. It might also be helpful to extend the tax deductibility beyond primary care, to the various specialties.