Finding congressional common ground to advance health issues

In an era of deep political divisions, there are days where it seems impossible for our two major political parties in Washington, D.C., to agree on anything of substance. In reality, the two parties aren’t that far apart on multiple health-related issues that would directly benefit patients by bolstering our physician workforce and expanding access to care beyond the exam room. As a nonpartisan organization, the AMA works with all lawmakers and policymakers who want to advance legislation important to the health of our nation.

Consider Medicare payment reform. A prime example of a bipartisan effort to help patients and physicians can be found in H.R. 2474, the Strengthening Medicare for Patients and Providers Act. This measure would link the annual Medicare physician payment schedule update to the Medicare Economic Index, an action the AMA has long advocated, and which also ties to the first pillar of the AMA Recovery Plan for America’s Physicians.

This legislation was introduced by a bipartisan coalition of physicians serving in Congress, including U.S. Reps. Raul Ruiz, MD, D-Calif., Larry Bucshon, MD, R-Ind., Ami Bera, MD, D-Clif., and Mariannette Miller-Meeks, MD, R-Iowa. The AMA and our partners in the Federation of Medicine enthusiastically support this effort to bring badly needed reform to the outmoded Medicare payment system. Hospitals, skilled nursing facilities and others paid by Medicare routinely receive substantially higher payment rates each year based on increased costs.

By contrast, physician practices have battled to reduce or delay payment cuts nearly every year. An annual inflation-based update is a vital consideration in helping physicians achieve practice sustainability, and also puts physicians on an equal footing with virtually every other provider paid by Medicare. This problem has been growing for two decades, which has resulted in a 26% reduction (PDF) in payment for physician services (inflation adjusted), which is one big reason why so many private practices are struggling to stay open.

Lawmakers on both sides of the aisle recognize the care delays, patient harm and practice hassles triggered by prior authorization—the overused, inefficient and purposely opaque requirements imposed by payers in the name of cost control. The harm to patients is concrete; more than one-third of physicians surveyed by the AMA said prior authorization led to a serious adverse event for a patient in their care. Fixing prior authorization is another pillar of the AMA Recovery Plan.

The good news here is the House Ways and Means Committee advanced multiple provisions earlier this summer aimed at bringing comprehensive reform to the PA process within Medicare Advantage. This action follows letters sent to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services. These letters earned the signatures of 61 senators and 233 House members, urging the finalization of a pending rule to overhaul prior authorization within Medicare Advantage.

Perhaps one of the most significant examples of bipartisan cooperation on health care legislation pending in Congress is the CONNECT for Health Act (S. 2016). The updated version of this legislation, brought forward by a group of 60 senators, will permanently eliminate all geographic restrictions on receiving telehealth services and allow health centers and rural health clinics to offer these services, among other provisions.

Passing this measure will open the door to a new era of patient care by building on the gains in telehealth achieved during the COVID-19 pandemic. A companion bill to the pending Senate legislation has already been introduced on a bipartisan basis in the U.S. House. Expanding telehealth services by giving more patients access to care is another pillar of the Recovery Plan, and the fact that legislation promoting this goal enjoys support that crosses party lines boosts its chances of becoming reality.

Bipartisan cooperation to advance health care workforce measures is nothing new in Congress. Consider the Conrad 30 waiver program. This effort dates to 1994, when Congress successfully advanced a measure granting each state the ability to waive the two-year home residency requirements for a certain number—initially 20, but raised to 30 in 2003—of international medical graduates (IMGs) who agreed to serve patients in federally designated shortage areas for three years.

Earlier this year, four U.S. Senators—two Republicans and two Democrats—introduced S. 665, the Conrad State 30 and Physician Access Reauthorization Act (PDF) to further strengthen the physician workforce in those sections of the nation most in need. Nearly 325,000 IMG physicians are practicing nationwide, comprising roughly one-quarter of our physician workforce.

In an effort spearheaded by our International Medical Graduates Section, the AMA is advocating further expansion of the Conrad 30 program to include more than 30 slots per state while also streamlining administrative visa requirements and reducing immigration and green card delays for IMGs.

No matter how we define ourselves politically, research shows that nearly all of us want to see the nation’s health care system function more effectively. The measures cited above, and many others not discussed here, demonstrate that common ground exists to achieve that goal. The AMA is and has always been willing to work collaboratively with lawmakers, policymakers and all other stakeholders to improve the health of our nation, and we urge all to join us in advancing this mission.