Published in RINewsToday on May 4, 2026
In 2023, Primary Care for All Americans (PC4AA) was launched as a national initiative to raise primary care as a public policy priority and advocate for payment reform to promote universal access to high-quality primary care. Primary care physician and former Rhode Island Health Director Dr. Michael Fine is the driving force and co-founder of PC4AA. He is also the author of several books, including “Healthcare Revolt” and “On Medicine as Colonialism.”
When asked why PC4AA was needed, Dr. Fine responded: “ We wondered about that ourselves. Physician groups tend to focus on pocketbook issues. Public health folks focus on health outcomes. But no one was putting it all together. And no one was specifically involving communities or showing them how they could provide primary care to everyone, in part because primary care is so affordable,” he said.
Dr. Fine explains the organization’s focus, stating: “Our mission is very clear. We exist to help communities figure out how to provide primary care to everyone, learning from the experience we gained in Scituate, Rhode Island.” In Scituate, the community locally funded a voucher program that successfully provided primary care to all uninsured residents for over two decades. “It’s the only place that we know of that assures everyone has access to primary medical and dental care,” he says, highlighting a replicable model.
Dr. Fine maintains that comprehensive primary care is a surprisingly affordable essential service, with its per-person cost comparable to municipal services such as police, fire, and road maintenance.
PC4AA’s influence and policy impact derive from the scale of its collaboration rather than from formal enrollment numbers alone. By uniting primary care physicians, health policy experts, patient advocates, academic leaders, and public health professionals, the coalition helps build nationwide consensus for health care reform—especially in making primary care accessible to all Americans, says Dr. Fine.
The coalition’s community-building efforts are apparent in its active workgroups. “We have over a thousand people in local or state workgroups who clicked ‘Join Us’ on our website, and they participate in some way,” says Dr. Fine. He further stresses that their growth is tracked by the number of these workgroups joining monthly online meetings and through the passage of primary care legislation at the state level.
Dr. Fine notes that the difficulty of accessing primary care inspired the creation of PC4AA. He notes that primary care uniquely improves public health while reducing costs, and that an adequate number of primary care doctors is essential to making healthcare affordable.
According to Dr. Fine, less than 43 percent of Americans have meaningful primary care relationships, a figure that is falling as fewer medical students choose primary care. Internationally, effective, affordable health care systems have at least 50 percent of physicians in primary care, he says.
Responding to these primary care workforce trends, PC4AA’s top priority is to expand access to primary care nationwide. “We need thousands of new primary care clinicians,” says Dr. Fine, explaining that this can be accomplished by establishing new medical and physician assistant schools and by increasing residency programs.
PC4AA also advocates for reducing primary care doctors’ workloads, eliminating preauthorization and cutting administrative duties, and improving reimbursement. Although accounting for less than 4 percent of health spending, primary care accounts for half of all patient visits, costing about $575 per person annually, out of an average total of $15,000.
Having operated for over three years Dr. Fine acknowledges a major challenge the group faces: a “feeling of impotence.” Although healthcare may seem “too big and scary for some” and many believe that “only the big guys can fix it,” Dr. Fine insists that the power to make systemic changes actually lies with communities. He points out, “Look at how Newport fought successfully to keep their birthing center open, or what Scituate did.”
While these may be viewed like temporary strategic challenges, Dr. Fine reframes these obstacles as chances for growth and community empowerment.
Fine argues that fixing the healthcare system requires a broad-based social movement, similar to past movements for abolition and suffrage, to restore community agency and build a system that serves people ahead of profit.
Communities can take forward-thinking actions to solve their own healthcare problems, says Dr. Fine, by creating local primary care reports, passing city council resolutions, and building scholarship programs to grow their own healthcare workforce.
“Get started, have a conversation, understand that you can do this because you can,” states Fine. He challenges readers to actively join the movement—by connecting with local efforts, attending on-line meetings, and spreading the message in their communities. “Take concrete steps, unite others, and turn awareness into real progress. Together, we can build the future of primary care from the ground up.”
PC4AA Welcomes First Executive Director
According to its March 31 newsletter, PC4AA announced the hiring of Neda Ashtari, MD, MPP, as its first Executive Director. This appointment arrives at a time when the nation is fiercely debating how to expand access to health care and reduce spiraling costs.
In the newsletter, PC4AA writes: “Dr. Ashtari brings to PC4AA something rare and deeply needed—a combination of lived experience, clinical insight, policy expertise, and movement-building leadership. As a physician serving in the safety net in Los Angeles during residency, she cared for patients managing a broken system where access too often depended on income and coverage status. She watched as patients were lost in the system due to insurance gaps or delayed medical care because of costs. These were not abstract policies; they were daily realities.”
The newsletter also highlights Dr. Ashtari’s own perspective: “I keep coming back to a simple conclusion,” she writes. “Lasting reform starts with universal access to primary care.” It notes that this conviction has guided her work for more than a decade across organizing, policy, and clinical care.
PC4AA further points out in the newsletter that Dr. Ashtari has led national advocacy campaigns, including the American Medical Student Association’s Lower Drug Prices Now initiative, coordinating organizing efforts across more than 30 chapters nationwide. Through her leadership with Universities Allied for Essential Medicines, she helped build coalitions that expanded access to lifesaving medications globally—work recognized in the documentary White Coat Rebels.
The newsletter emphasizes that she co-founded Protect US, a public health nonprofit focused on expanding access, strengthening public health infrastructure, and combating misinformation. After serving as Associate Director of Health Policy at the Center for American Progress, Dr. Ashtari recently assumed a new role as Director of Federal Affairs at the American Medical Association, where she advocates on behalf of clinicians and patients on Medicare Advantage policy.
Looking forward, Dr. Ashtari outlines her vision for the role in the newsletter: “As PC4AA’s Executive Director, I will work to translate the organization’s grassroots energy into a durable national movement—one capable of changing how primary care is valued, funded, and delivered across the country.”
The newsletter closes by emphasizing a consistent theme across her work: Dr. Ashtari is “not only a thinker, but a builder,” noting that she understands policy alone is not enough—lasting change requires organizing and translating values into durable systems that people can rely on.
Mark Your Calendar
The organization is convening the “Health Care Renaissance Summit,” its inaugural gathering to build a coordinated national movement for primary care reform. The summit, scheduled for May 20, 2026, at the Le Méridien Hotel in Cambridge, MA, brings together an eclectic group of stakeholders—including clinicians, community organizers, medical students, policymakers, and advocates—reflecting PC4AA’s strategy of linking grassroots organizing with policy change.
“According to PC4AA, this one-day national summit is designed to be interactive and results-driven. The event features keynote speaker Dr. Jonathan Fitzsimons—a family physician and Medical Lead of the Renfrew County Virtual Triage and Assessment Centre—along with talks from national leaders, skill-building workshops, and “table talks.” These joint sessions allow participants to share strategies and unique experiences. Core discussions focus on practical approaches, such as advancing local policy resolutions, launching student-driven initiatives, and strengthening state- and community-based coalitions.”
Organizers hope attendees leave the summit with practical tools for local organizing and real-world examples to bring home to their communities. The event connects people to a national support network and advances PC4AA’s mission to expand primary care access through community-led work that creates lasting change.
Ticket Pricing is $50 for students and $250 for general admission. Register now at https://pc4aasummit.netlify.app/# to be part of this movement for healthcare reform and help drive change in primary care in your community.
Summit sponsors include: New Bedford Community Health (New Bedford, Massachusetts); City of Pawtucket (Pawtucket, Rhode Island); Tufts University School of Medicine, Department of Family Medicine; The Meyers-Keller Fund for Good Works (Denver, Colorado); Elation Health (San Francisco, California); and Michael Kaplan, MD(Lenox, Massachusetts).
To visit PC4AA’s website, go to https://primarycareforallamericans.org/
Listen to Dave Chase’s Relocalizing Health podcast interview with Dr. Michael Fine, “How Primary Care and Community Agency Can Transform Healthcare from Extraction to Empowerment,” at: https://relocalizinghealth.com/episode/how-primary-care-and-community-agency-can-transform-healthcare-from-extraction-to-empowerment
Tag Archives for Medicare Advantage plan
Medicare slow to fix equity issue for seniors’ access to at-home COVID test kits
Published on Feb. 7 in Rhode Island News Today
Today home test kits were made available in a variety of ways – but, for Medicare recipients, it was a different story, being forced to go thru a different purchasing and payment process than those having private insurance, or no insurance. That process required the oldest and most at-risk population to take more than several steps, put up their own money, do a lot of paperwork, to seek reimbursement.
The White House made changes in testing so that at-home tests are now fully covered by health insurances. Those insured can pick up their test kits in a store and have them paid for at the time of purchase by their insurance, at no cost to the person. They aren’t required to visit their physician or get a prescription to obtain the free test. They have a limit of 8 test kits per month.
But, when the program began, this was not the plan for those insured through the government’s Medicare and Medicare Advantage plans.
Red Tape… Upfront Charges for COVID-1
Jane, a 65-year old Medicare beneficiary from Warwick went through the steps to get a kit after a relative she had seen found out she was exposed to COVID. Before Medicare announced easing up on the purchasing process of COVID-19 test kits, she expressed frustrations to this writer about the regulatory hoops she faced because she was on Medicare – purchasing the test kits and getting reimbursed for the upfront charges. “First, I had to request a prescription from my physician and say that I had either been exposed to someone who had COVID, or I was having symptoms, myself,” recalls the frustrated Medicare beneficiary. “Once my physician sent the prescription over to CVS, I was notified that it would take a couple of days before I could pick up the kits and that I would only be given two kits per prescription”, she fumed, knowing that sometimes it takes 4 or 5 days of testing to test positive, but was only eligible to receive two, and she might have to go through the whole process again in a few days.
“Three days later CVS finally left me a message saying these kits were in. I used the drive-up window for pickup and the cashier asked me for $46,” Jane remembered. “When questioning this charge, a pharmacist came to the window to assist and told me that I had to pay for the kits upfront and then seek reimbursement,” she added.
Paying for the kits, Jane went home, and called Blue Cross, her Medicare supplement company and was told she needed to request a copy of the prescription which took hours to finally request with the back and forth phone calls to her busy doctor’s office. It was almost two weeks later she finally got a copy of the receipt detailing her $46 payment for the kits. She was then able to upload the copy of the prescription and a copy of her receipt to a BCBS reimbursement screen on her computer (or she could have printed the form out and mailed the whole package in). At press time, Jane is still waiting for her reimbursement, being told it will take from 4 to 6 weeks to receive a check.
It’s better late than never, says Jane, when she heard that Medicare would now cover free over-the-counter COVID-19 tests. “Not everyone can put out $46 and wait two months to get it back, home health tests were made available in a variety of ways – but, for Medicare recipients, there was a different process. More concerning was all the steps I had to take to complete the process they had originally intended for us to do. How many people would really complete all those steps?” she says. “We talk a lot about equity, but seniors need equitable healthcare processes, too.”
Just days ago, the Centers for Medicare & Medicaid Services (CMS) announced that beneficiaries in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, estimated to be in April. Under the new CMS initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). A prescription will not be required.
CMS Unveils New Medicare Benefit
According to CMS, this new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.
CMS’s announcement follows last month’s announcement that the Biden-Harris Administration would be requiring commercial health insurance companies to cover at-home COVID tests for free.
Until the new benefit kicks in, Medicare beneficiaries can access free tests through a number of channels established by CMS, too. Now, they can request four free over-the-counter tests for home delivery at covidtests.gov. Or beneficiaries can access COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. Many cities and towns are also giving out free test kits at drive-up handout programs as the state receives supplies.
CMS’s Feb. 3 statement noted that Medicare beneficiaries can also access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, says CMS.
In addition, CMS says that Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits. Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.
Finally, all Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.
“AARP applauds today’s announcement that will guarantee access to at-home over-the-counter COVID-19 tests at no cost for Medicare’s 64 million beneficiaries and we thank [Health and Human Resources]Secretary Becerra and CMS Administrator Brooks-LaSure for their diligence in addressing this issue. Expanded access to no-cost testing will help protect seniors who have been hit hardest by the pandemic and ensure they can remain connected with their loved ones and community.,” says AARP Executive vice president and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement issued with CMS’s Feb. 3rd announcement of the new Medicare benefit.
“Every American should have an easy way to get at-home COVID tests. We know that people 65 and older are at much greater risk of serious illness and death from this disease – they need equal access to tools that can help keep them safe. The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus, adds LeaMond.
Successfully Advocating the Seniors
Last month, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI) along with 17 of their Senate colleagues including Rhode Island Democratic Senators Reed and Sheldon Whitehouse wrote to HHS Secretary Becerra and CMS Administrator Brooks-LaSure urging them to expand Medicare coverage of free at-home rapid COVID-19 testing.
Aging groups also joined the Senators in pushing Medicare to offer the new testing kick benefit. “It is clear that regular testing is a crucial part of managing the spread of COVID-19. That’s why AARP has been calling for coverage of at-home tests, says AARP’s LeaMond, noting that the nation’s largest aging advocacy group “will continue to watch for details about when and how at-home COVID tests are made available to those in Medicare.”
Thankfully CMS quickly heeded their calls.
For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)
Stay tuned for free N95 masks to be made available to all coming up soon.
Herb Weiss 