This afternoon, the House Ways & Means Health Subcommittee is holding a hearing on how the United States can modernize care coordination to treat and prevent chronic illnesses. The hearing is timely: the scourge of chronic conditions and the heavy burden they place on families and the economy has only grown in recent years.
As the PCC highlighted in an issue brief earlier this year, more than 60% of Americans live with a chronic condition, and 42% live with multiple chronic diseases. Millions more face a significant risk of developing one. And the prevalence of chronic conditions among the Medicare population is even higher as the United States endures decades of systemic decline in prevention, care coordination and sustained primary care access.
Even though the U.S. spends more on health care as a share of our economy than all other nations, U.S. adults are significantly more likely to have multiple chronic conditions than adults in other countries — which means American companies are competing in a global economy with a sicker workforce. The American health care system fails to promote a healthier, happier population.
And that failure to prevent chronic disease — physical and mental — is, in part, a result of a reactive, rescue-focused, siloed medical care system that has underinvested in primary care for decades. Primary care accounts for just 3.9% of Medicare spending, far below what a mounting body of research shows is necessary to prevent disease progression, coordinate comprehensive care and support long-term health. Clinicians now operate in a system that rewards volume over value, making it difficult to provide continuous, whole-person primary care.
The PCC encourages Congress to embark immediately on a bipartisan effort to rebalance the Medicare program to strengthen primary care and enable whole-person primary care that addresses risk factors like diet and behavioral health.
There have been bright spots.
Congress should build on important reforms that CMS has advanced in the Medicare Physician Fee Schedule, particularly coverage for Advanced Primary Care Management (APCM) expressly intended to provide resources for primary care and behavioral health clinicians to provide proactive, whole-person primary care for Medicare beneficiaries. The APCM code also is intended to reduce the growing documentation burden on primary care.
In 2026, due to a new efficiency adjustment and other reforms in the latest Medicare payment rule, CMS projects that non-facility-based reimbursement for primary care specialties will rise by 4–8% with additional increases tied to the conversion factor. These updates move primary care toward sustainability and acknowledge its essential role in addressing chronic conditions.
But important as they are, these changes alone are not enough to create a system that gives people the support they need to prevent and manage chronic conditions.
If Congress is serious about addressing the scourge of chronic illness, they must take real, substantive steps that bolster primary care and begin rebuilding the foundation of the American health care system.
The PCC urges Congress to build on the bipartisan Senate Finance Committee white paper from the previous Congress, along with bipartisan legislation sponsored by Senators Cassidy and Whitehouse, to further strengthen the foundation and front door of health care—primary care.
Here’s what it will take to expand access to whole-person primary care that prevents and controls chronic conditions so Medicare beneficiaries can live healthier lives:
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Doubling the investment in primary care over the next five years
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This investment should leverage value-based payment models that resource primary care teams with upfront population-based payments to take proactive care of people in their communities.
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Unshackle doctors, NPs, PAs and other caregivers from the red tape of conflicting, complicated payment rules and programs so they can spend more time with patients.
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Shift Medicare to a mindset of prevention, wellbeing and effective chronic care by strengthening primary care and building systems around trusted primary care relationships.
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Empower Medicare beneficiaries to choose a primary care professional and team to support them in their care journey toward better health and wellbeing.
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Remove patient financial barriers that hinder chronic disease management.
Only by revisiting how and what the American health care system pays primary care can we begin to reverse decades of rising rates of chronic illness.
By investing in robust, continuous primary care, the United States can help prevent chronic disease, improve management for the millions living with these conditions, and create a strong path toward better health and lower overall costs.
For more details on how policymakers can strengthen efforts to address chronic conditions, please see PCC’s issue brief, Make Medicare Beneficiaries Healthier by Strengthening Primary Care