Patients should not have to fight the healthcare system to get the care they need and deserve. Yet that is exactly what too many face today. An unstable Medicare payment system threatens their ability to see a physician, while burdensome prior authorization requirements often delay or deny medically necessary care.
As Congress returns to Washington this month, lawmakers have an opportunity—and an obligation—to address both before the end of the 119th Congress. They should not wait for the next Medicare payment crisis or the next patient whose care is delayed by an insurer. Bipartisan solutions are already on the table to strengthen Medicare physician payment and reform prior authorization. What is needed now is the political will to finish the job.
These are distinct policy challenges, but for patients, the consequences converge. Whether a physician practice can no longer afford to accept Medicare patients or an insurer puts unnecessary obstacles between a patient and needed treatment, the result is the same: care becomes harder to access. Congress can change that.
For more than two decades, Medicare physician payment has failed to keep pace with the cost of practicing medicine. From 2001 to 2026, the cost of running a medical practice increased 63%, while Medicare physician payment rose only 10%. Adjusted for inflation in practice costs, Medicare physician payment actually dropped by 33% over that period.
Physicians cannot keep absorbing that shortfall.
Physician practice staff salaries increase. Rent, technology, supplies, medical professional liability insurance and regulatory requirements all cost more. Yet physicians remain the only major Medicare provider category without a permanent annual update tied to inflation.
Temporary fixes may prevent an immediate crisis, but they do not create a sustainable payment system. Putting a bucket under a leaky roof may keep the floor dry for a while, but eventually the roof has to be fixed.
Putting patients first
Congress can address this by passing the bipartisan Patients First Act of 2026 (H.R. 9693). Introduced this summer, the legislation would address longstanding problems in Medicare physician payment, including payment stability, budget neutrality and the burdens associated with the current quality-payment system.
This is not about giving physicians favors or special treatment. Rather, it is about making sure the Medicare payment system can keep practices open and patients connected to care.
When payments consistently fall behind the cost of providing care, practices have to make difficult choices. Some limit the number of Medicare patients they see. Some consolidate with larger health systems or other organizations. Some close. In each case, patients suffer. The pressures are particularly difficult for small, independent and rural practices.
Patients experience those decisions as longer waits, fewer choices and greater difficulty finding a physician.
Finally fixing prior auth
Congress should also act on prior authorization reform in Medicare Advantage by passing the Improving Seniors’ Timely Access to Care Act (H.R. 3514/S. 1816).
The need could not be clearer. The AMA’s latest survey of 1,000 practicing physicians found that doctors complete an average of 40 prior authorizations each week, consuming about 13 hours of physician and staff time. Ninety-five percent say prior authorization delays necessary care. Seventy-nine percent report that patients abandon treatment because of authorization challenges, and 26% say prior authorization has contributed to a serious adverse event for a patient.
Those numbers are of concern to everyone, not just physicians. While insurers continue to make voluntary commitments to improve the process, physicians remain skeptical. Only one in three physicians surveyed by the AMA believes the latest insurer pledge will make a meaningful difference.
Pledges and statements of commitment are meaningless unless backed by action to solve the problem.
That is why voluntary promises are not enough. Patients need enforceable standards.
The Improving Seniors’ Timely Access to Care Act would modernize prior authorization in Medicare Advantage, streamline electronic processes, improve transparency and move toward faster, more predictable decisions. The legislation has already demonstrated the kind of bipartisan momentum that Congress should build on. In July, the House Ways and Means Committee and Energy and Commerce Committee advanced the bill unanimously.
That is what bipartisan policymaking looks like.
Clear choices for Congress
The AMA urges Congress to use the remainder of this session to deliver results for patients and to put healthcare on a more sustainable path for the future.
The choice is straightforward: Continue relying on temporary fixes, voluntary promises and a payment system that falls further behind the cost of care, or work across party lines to build a Medicare system that is more stable, predictable and patient-focused.
Physicians and patients are doing our part. We need Congress to do theirs.
