This article originally appeared in The Hill on December 28th, 2025.
A bipartisan bill in Congress could finally give Medicaid patients something most of them lack today: reliable, relationship-based primary care.
This month, Sens. Marsha Blackburn (R-Tenn.) and Mark Kelly (D-Ariz.) reintroduced the Medicaid Primary Care Improvement Act, a bill that previously passed the House of Representatives and would allow states to contract directly with direct primary care (DPC) practices — membership-based clinics built around continuous, accessible, preventive care. For Medicaid enrollees, this would mean predictable, straightforward access to a personal physician, instead of sporadic, expensive emergency room visits. And for conservative policymakers who continue to push for more patient choice in how their federal health care dollars are used, the bill offers a meaningful new option.
When routine needs are addressed in episodic, high-cost settings instead of through continuous primary care relationships, expenses rise and patient outcomes worsen. American patients are currently suffering from this dynamic, largely due to the widening gap between demand and supply for primary care services. In the United States, primary care is on the decline. From 2021 and 2022, primary care visits fell by 6 percent, continuing a downward trend since 2008, where some survey results show per person drops as high as 25 percent.
Emergency departments, specialists and urgent care centers have picked up more of the slack, with urgent care in particular experiencing rapid growth in both utilization and clinic openings in recent years. Those settings are useful and sometimes lifesaving, but they are not designed to deliver continuous, preventive care or to manage chronic conditions over time — the unique domain of primary care doctors, where DPC clinics have developed a successful alternative.
Direct primary care (DPC) is a simple but transformative model: patients — or in this case, Medicaid — pay a flat monthly membership fee (typically around $75) for comprehensive primary care services, including walk-in visits. Because DPC practices largely opt out of traditional insurance billing, physicians escape the administrative burdens that dominate fee-for-service offices and can devote far more time to their patients. Surveys show that 98 percent of DPC practices offer same-day appointments, and visit lengths are often run two to three times longer than conventional clinics. By contrast, the average wait time for a primary care appointment outside the DPC model is roughly 20 days.
