Investing more in primary care is linked to lower health care costs, according to a new report.
Journalists can cover this story nationally and locally, especially in rural areas where access to primary care can be more challenging, according to the report, “Investing in Primary Care: The Missing Strategy in America’s Fight Against Chronic Disease,” from the Milbank Memorial Fund.
The report matters to reporters because it shows that adults and children with primary care physicians (PCPs) or a regular source of primary care have lower health care costs than those without.
The report comes as Congress and President Trump are implementing changes under the 2025 budget reconciliation bill, cutting billions of dollars in federal Medicaid spending. Such a big decrease means low-income families could lose their Medicaid coverage, and not all physicians will treat the uninsured, the Milbank report notes.
The Milbank report is also timely because federal efforts since 2021 to increase the number of primary care doctors “have fallen short”, as Dennis Thompson reported for HealthDay. Primary care positions increased by just 2% under laws Congress passed in 2021 and 2023 to increase U.S. medical residencies, while residency positions in interventional radiology and psychiatry increased the most, rising by 16% and 13% respectively, he wrote, citing research JAMA published in June.
Budget cuts could further endanger primary care
Despite the benefits of primary care, access to PCPs has become challenging, according to a report from the Health Care Cost Institute last year, “4% of Health Spending Goes to Primary Care.” Last year, HCCI noted 7,901 primary care health professional shortage areas. The report also showed that the number of PCPs per person declined between 2012 and 2021, and that fewer trainees pursued primary care rather than specialty care during those years.
Even before Congress cut almost $1 billion in federal funding, Medicaid rates were so low in many states that physicians and other providers were closing their practices, said Morgan F. McDonald, M.D., the Milbank Memorial Fund’s national director of population health, in an interview. As McDonald noted, another story to cover is what happens when physicians and other providers close their offices, leaving more Medicaid patients unable to get the care they need. To assess the number of primary care providers, see these KFF reports:
- Professionally Active Primary Care Physicians by Field
- Primary Care Health Professional Shortage Areas (HPSAs).
The ripple effect of raising Medicaid rates
While health insurers are reluctant to boost what they pay for primary care, insurers should at least match what Medicare pays, McDonald explained.
“States control their Medicaid rates, and when they want to increase access to primary care, they increase their Medicaid rates to be closer to what Medicare covers,” she added. “We know that keeps providers practicing, and it opens doors for patients to have primary care providers see them.
“When states increase Medicaid rates, there’s a ripple effect that enables doctors to take care of more Medicaid patients,” McDonald noted. “Also, you increase the viability of practices, expanding access for everyone.”
Numbers tell the story
Paying physicians enough to treat Medicaid members gives more patients access to a usual source of primary care. Access to regular primary care is associated with greater use of needed preventive care, such as vaccines and treatment for chronic conditions, the report noted. Almost all adults (95.5%) who have a usual source of primary care get the preventive services they need for chronic conditions such as heart disease and cancer compared with only about two-thirds (67.6%) of adults who do not have access to primary care, the report showed.
When compared with adults who lack a usual source of primary care, adults who have a PCP and a chronic disease incur nearly 54% lower total health care costs, the report added. Children with chronic disease who have a PCP have nearly 40% lower total health costs than children with a chronic condition who do not see a PCP regularly, the report added.
Also, a child who has a usual source of primary care is more likely to get vision testing and prevention counseling against obesity, accidents, injuries and exposure to secondhand smoke, the report noted.
Health systems turn to primary care
Other stories to cover about primary care include the steps some health systems and health plans have taken to invest in more robust primary care, such as a five-year initiative from the Health Plan of San Mateo. HPSM is a nonprofit health plan serving 150,000 residents of San Mateo County, Calif., including Medi-Cal and dual Medicare and Medi-Cal members. In fall 2025, HPSM announced plans to invest $60 million in its Primary Care Investment Strategy, including grants to primary care providers and coaching and technical assistance for primary care staff.
In April, the Milbank Memorial Fund published this report, “Revitalizing Primary Care: Health Plan of San Mateo’s Investment Strategy,” describing the steps HPSM is taking to improve primary care.
Milbank has also featured the work of accountable care organizations that the federal Centers for Medicare and Medicaid Services recognizes as groups of physicians, hospitals and other providers who work together to coordinate care, improve patient outcomes and lower costs.
In December 2025, Milbank published this article, “The Pathway to Primary Care Investment Is Bolstered by Accountable Care,” written by Farzad Mostashari, M.D., The CEO and co-founder of Aledade.
In the article, Mostashari explained that more than 20 states have developed policies to measure how much they spend on primary care, including those planning to spend more. “These states have prioritized preventive medicine, understanding that investing more in primary care can reduce the total cost of care over time by replacing expensive emergency room visits with annual wellness visits,” he wrote.
Resources
- How Primary Care Medics Can Bring Needed Health Care to Rural Americans, The Commonwealth Fund, July 23, 2026
- Changes in Specialty and Geography of Medicare’s New Residency Positions, JAMA, June 15, 2026.
- The Primary Care Investment Guide,” The Primary Care Collaborative, Dec. 18, 2025.
- State Task Force Recommends Rebalancing Health Care Spending to Support Primary Care, Massachusetts Health Policy Commission, Dec. 15, 2025
- The first step to addressing the physician shortage, STAT, Jan. 18, 2025
- Increasing Investment in Primary Care — Lessons from States, The Commonwealth Fund, April 3, 2024
