By Melissa Patrick, Kentucky Health News · August 17, 2026

The Kentucky Academy of Family Physicians is on a mission.

“Oh, we have lots of thoughts about how things are going in family medicine,” said Dr. Patty Swiney, co-chair of the academy’s advocacy committee. She has been a member since she was in residency and also is a past president.

Although Swiney practices in Paris – she calls it “a rural town of haves and have-nots” due to the horse industry – she and others with the advocacy group have fought hard in front of the legislature to stand up for patients from all over rural Kentucky.

“I used to be one of those people that lived my life by the ostrich approach – stick your head in the sand and let the world pass you by, so you don’t have to deal with anything,” she said.

But Swiney saw first-hand how laws were impacting patient care and decided she needed to pull her head out of the sand.

“I really enjoy talking to legislators and understanding how to see both sides and how everything interacts and interplays with everything else,” she said.

Swiney’s husband grew up in Eastern Kentucky. “And when we would go down there, I would see how things were and hear him talk about growing up there. They have a very low employment rate, don’t have industry and don’t have the infrastructure to get it.”

Swiney said a major problem is that we have a system that relies on employer-based insurance. “To get insurance, that’s how you fund it. My husband works for our insurance for our family – I’m self-employed and in a solo practice, so he did that so we’d have health insurance.”

That’s great, she said, but in Eastern Kentucky it can be next to impossible to find a job that also provides insurance. “So there’s a higher uninsured rate, more sickness. It all goes hand-in-hand.”

(Editor’s note: In Kentucky, some people can also obtain health insurance through the Affordable Care Act, which allows Medicaid coverage for people with incomes up to 138% of the federal poverty line. And some Kentuckians can also get federally subsidized health insurance through Kynect, which houses the state-based marketplace.)

Need for policy change

Swiney said she began to realize that working towards policy change was a way to advocate for her patients, to help them live better lives and have better healthcare.

“There are access issues – and it happens whether you’re in rural or Eastern Kentucky, or on the edge. Transportation is a big deal,” Swiney said. “It’s a huge factor everywhere; I get so frustrated.”

She added that many don’t see the other side to access that many physicians and clinical workers do.

“Have you ever tried to teach a schizophrenic how to log onto Zoom? We can spend the entire appointment just trying to get telehealth up and going … Or have you tried to teach someone who’s 70 and on Medicare how to use technology?”

But Swiney said regardless of the technical issues and work-arounds, telehealth is still a valuable tool.

“And these extensions and flexibility – telehealth with our Medicare patients, it’s extended through this year, the funding. So they will pay us to see Medicare patients through telehealth just as if they’re in the office.”

However, the Consolidated Appropriations Act, 2026 only extended the pandemic-era rules to allow for the Medicare telehealth flexibilities through December 2027.

“It’s hard to tell your patients that funding is running out for them to get healthcare, when they come in and say, ‘We don’t get paid for another week, can we borrow some toilet paper from your office?’ just to be able to survive. These patients cannot afford toilet paper; women can’t afford menstrual hygiene products or to eat healthy, and that’s what I go tell legislators.”

This year, Swiney said there was a record-breaking attendance of 353 family physicians, residents and medical students from across the country attending the Family Medicine Advocacy Summit in Washington.

“We try to choose bipartisan, but everyone has a different opinion.”

The group is currently focused on the Chronic Care Management Improvement Act of 2026, or H.R. 8261. The Act proposes to remove patient cost-sharing obligations for chronic care management services under Medicare, to make these services more accessible to seniors.

Swiney said family physicians are pushing for the bill because they say it eliminates patient financial barriers, since chronic care typically costs senior patients a monthly out-of-pocket fee, causing some in this already vulnerable population to decline services.

“With primary care, that’s where it’s at, ” Swiney said, referring to chronic care management. “Internal, family and pediatrics, sometimes OBGYN comes in for their chronic pain. So this basically removes barriers so they aren’t responsible for funding it,” she said.

The American Academy of Family Physicians data shows that proper, continuous chronic care management actively lowers overall emergency health expenses, and that giving seniors free access to care management saves Medicare money by preventing avoidable hospitalizations.

Swiney said the group also supports the Medicare Advantage Improvement Act of 2026.

“I’m sorry, but we doctors call it the ‘Disadvantage Plan,'” she said.

Swiney is referring to H.R. 8375, a major federal bill designed to crack down on abusive insurance practices, speed up care approvals and increase transparency within the Medicare Advantage Program.

She said the Medicare Advantage program, the private-run, government-funded alternative to traditional Medicare, is “paid by Medicare, to supply healthcare for them just as if they had commercial insurance. But it’s limited to a network of providers, there are co-pays, they need prior authorizations for everything,” she said. “It usually costs more to do a plan like that, and it’s very limited. I hate it – we can’t get anyone into physical therapy without it costing money, can’t get them into a skilled nursing facility for rehabilitation … It takes an act of God.”

She noted that these plans were developed in part to try and manage the Medicare spending. “That’s how it’s supposed to work, but it doesn’t work.”

Swiney said the programs are actually limiting the ability of patients to get the care they need promptly.

“And another thing – ‘The One Big Bad Bill,” as we call it (officially called ‘The One Big Beautiful Bill Act’ or H.R. 1)– this is part of the problem for Kentuckians.” The law slashed over $1 trillion from federal safety-net spending, making it the largest rollback of Medicaid funding in U.S. history.

(Editor’s note: Proponents of the bill’s passage say it will eliminate waste, fraud and abuse within the Medicaid program, thus making it a stronger program for those who most need it.)

Finding new ways to care for patients

Swiney said in all this discussion about rural healthcare, there’s an important point some don’t realize. “There’s a difference between healthcare coverage and healthcare. Coverage is insurance, or some form of payment. Healthcare is where I take care of you, and that’s the access problem for a lot of Eastern Kentucky folks.”

In rural areas, some patients are waiting three months to see a physician. “And primary care really needs to be emphasized – we do about 95% of the work, but we’re the lowest paid.”

And with most insurance policies, around $3,800 is the bare minimum Swiney has seen for a deductible to be met before the policy kicks in and pays. “I have patients where their deductible is $7,000. Patients are going into medical debt – bankruptcy, even, to get medical care.”

At Swiney’s practice, she offers a program called direct primary care. “I take Medicare – if you put into the system for Medicare (by paying taxes), you deserve to use it. I don’t take any other insurance besides those, and they pay a monthly fee.”

It’s akin to concierge medicine, where patients pay a membership fee. She said she charges $50 a month for adults and $15 for kids.

“I don’t have to bring you into my office to get your co-pay or deductible; I can do that over the phone, ” Swiney said. “I can treat over the phone sometimes, too. They tell me their symptoms, send a picture of their throat and we can treat them.”

Her practice normally sees patients within 24 to 48 hours. “If they have a laceration, I will meet them in the office. We will sew them up, and they’ve already paid me, and that includes everything. We dispense medicines from here.”

Employers also will pay the monthly healthcare fee to Swiney’s practice for employees. “It keeps them more productive and not calling in sick because they can’t get into a doctor, or can’t afford to because of their deductible.”

Swiney said, “If you can get healthcare for $600 to $900 a year, my goal is to not let you meet your deductible before you can get healthcare.”

She’s been practicing under direct primary care since 2017. “I was in private practice with partners and did ER also … but I got burned out. I realized the healthcare system was awful … People were trying to get in because there weren’t doctors out there who could get them in. I decided to not be a part of the problem, so I started my own practice.”

Bobbie Curd is a freelance journalist based in Danville, Kentucky. Her stories appear in a variety of area publications, and her experience includes reporting and editing duties at both daily and weekly newspapers. This story is part of a package about health care issues in Eastern Kentucky produced with a grant from the Foundation for a Healthy Kentucky.