Sept. 5, 2025: National Advocacy Update

Trump administration removes CDC director; additional CDC senior staff resign

In a contentious move that has raised rare bipartisan concern from Congress, the Trump administration last week removed Centers for Disease Control (CDC) Director Susan Monarez, PhD, from her post, only a month after her confirmation. Immediately following her removal, several senior career CDC staff resigned from the agency, including Deb Houry, MD, MPH, chief medical officer and deputy director for program and science; Demetrious Daskalakis, MD, director of the National Center for Immunization and Respiratory Diseases; Daniel Jernigan, MD, director of the National Center for Emerging and Zoonotic Infectious Diseases; and Jen Layden, MD, director of the Office of Public Health Data, Surveillance, and Technology.

Following the removal of Director Monarez and resignations of top staff, the AMA expressed its serious concern over the staffing turmoil, with AMA President Bobby Mukkamala, MD, expressing his concern that “this turmoil leaves us highly susceptible to public health threats.” 

The administration has appointed Jim O’Neill as the Acting Director. Mr. O’Neill had previously served as Deputy Secretary of Health and Human Services under current Secretary Robert F. Kennedy Jr. The AMA will continue to monitor the ongoing impacts on CDC and will continue to advocate for action that promotes the CDC’s important work and to protect the public’s health. 

FDA authorizes updated COVID-19 vaccines, revokes authorization for some populations

The U.S. Food and Drug Administration (FDA) last week issued marketing authorizations for updated COVID-19 vaccines for the 2025-2026 respiratory season. The marketing authorizations for vaccines from Pfizer/BioNTech and Moderna are limited to individuals aged 5-65 with at least one risk factor for serious COVID-19 and for individuals over 65. The marketing authorization for the vaccine from Novavax is authorized for individuals aged 12-65 with at least one risk factor for serious COVID-19 and adults over 65. The updated vaccines will not be authorized for young children or healthy adults under 65.  

Along with the market authorization approvals, Center for Biologics Evaluation and Research Director Vinay Prasad issued decisional memos requiring several additional randomized, placebo-controlled trials for each vaccine. In issuing the new requirements, Director Prasad cited a “suggested net harm of ongoing vaccination in low-risk populations” and cited concerns over the risk of myocarditis and “multiple thrombotic” risks. 

The removal of marketing authorizations for all but high-risk populations and the potential for more limited recommendations from the Advisory Committee on Immunization Practices (ACIP) will make COVID-19 vaccinations difficult to obtain for many Americans. Laws in several states limit the ability for pharmacies to administer these vaccines absent a clear ACIP recommendation, and insurance coverage may change for many given the lack of FDA authorization for healthy populations and more limited ACIP recommendations. However, in a somewhat contradictory statement, Health and Human Services Secretary Robert F. Kennedy Jr. has pledged that vaccines will remain available to those that want them.  

The AMA earlier this year expressed (PDF) significant concern regarding the FDA’s move to require randomized, placebo-controlled trials for COVID-19 vaccines and to change vaccine authorizations without utilizing its traditional advisory committee and public comment processes. The AMA has also continued to express serious concern about ACIP’s actions to limit recommendations for COVID-19 and other vaccines, raising the need to ensure continued access to these important public health interventions.

Cigna Downcoding Policy will lead to unfair payment reductions, administrative burdens for physicians

The AMA recently sent a letter (PDF) to Cigna Healthcare requesting that the health plan immediately rescind its new Evaluation and Management (E/M) Coding and Accuracy policy. Under this policy, which goes into effect on Oct. 1, 2025, Cigna may reduce payment for E/M Current Procedural Terminology® (CPT®) codes to a lower level if the plan believes that information on the claim does not support the higher-level E/M code. The AMA asserted that this policy conflicts with current E/M coding guidelines and will result in unfair payment reductions for physicians. In addition, the AMA stressed that the burdens associated with invalid downcoding will be placed squarely on physicians and their staff, who will be forced to waste valuable time filing appeals to fight for correct payment instead of being able to focus on patient care. As an alternative approach, the AMA offered to partner with Cigna on an educational campaign addressing correct use of CPT E/M codes.

AMA-led sign-on letter encourages thoughtful implementation of digital quality measures

A priority of the Trump administration is to transition quality measures used in Centers for Medicare & Medicaid Services (CMS) programs to digital measures within the next two years. Digital quality measures (dQM) use standardized, digital data from various interoperable health information sources, not just Electronic Health Records (EHRs). DQMs utilize the Fast Healthcare Interoperability Resources (FHIR) standards that reduce manual quality reporting, enabling more accurate, real-time measurement of care and a more holistic view of patient health, as opposed to electronic quality measures (eCQMs). While the AMA supports advancing quality measurement, the AMA along with 30 national medical specialty societies sent a sign-on letter (PDF) to the CMS administrator to amplify our concerns with the aggressive timeline due to the variable state of vendor, physician and provider readiness. The letter also outlines recommendations to better ensure a successful transition and offers medicine’s assistance in the planning and execution. 

Reauthorization of key physician workforce programs would address growing shortages

The AMA sent a letter (PDF) to Energy and Commerce Health Subcommittee Chair, Congressman Morgan Griffth (R-VA), and Ranking Member Congresswoman Dianna DeGette (D-CO), thanking them for their leadership and expressing strong support for congressional efforts to reauthorize the Health Resources and Services Administration’s (HRSA) Title VII health professions workforce development programs, which are set to expire on Sept. 30. In the letter, the AMA underscored the critical importance of these programs in strengthening the physician workforce and improving access to care, particularly in rural and medically underserved communities. 

Projections indicate the United States could face a shortage of up to 86,000 physicians by 2036. Compounding the challenge is the anticipated 48% growth in the over-65 population by 2032 and a steep decline in the number of rural physicians, with a quarter fewer expected to be practicing by 2030. 

Title VII programs directly confront these challenges by supporting training, scholarships, and clinical education initiatives across the country. In the 2021–2022 academic year alone, the programs helped fund education for approximately 3,000 primary care students, 32% of whom came from rural backgrounds, across 383 health care delivery sites, 68% of which were located in medically underserved areas. In addition, Title VII resources supported continuing education for more than 500,000 health care professionals in geriatrics, scholarships for 148 medical students, and primary care training for about 500 residents. 

The AMA applauds the bipartisan leadership of Representatives Griffith and DeGette and remains committed to working with Congress to advance this essential legislation during the 119th Congress. 

More articles in this issue

• Sept. 5, 2025: Advocacy Update spotlight on hearing on AI in health care
• Sept. 5, 2025: State Advocacy Update