Featured topic and speakers
This webinar offers a timely and in-depth look into the complex health care issues facing the U.S. in the coming year and how the AMA is working to shape the landscape. Amid shifting priorities among policymakers, hear about the strategies organized medicine is using to meet the moment—advancing health policy to better meet the needs of patients and physicians.
Host
- David H. Aizuss, MD, chair, AMA Board of Trustees
Speakers
- Todd Askew, senior vice president, AMA Advocacy
- Michaela Sternstein, vice president, Advocacy Resource Center, AMA
Transcript
Dr. Aizuss: Hello, and thank you for joining us today for the latest in the AMA Advocacy Insights Webinar Series. I'm David Aizuss, board chair of the American Medical Association and an ophthalmologist in private practice in Southern California. It's my pleasure to welcome all of you here today, to set the table for today's discussion, which focuses on the shifting health policy landscape at the state and federal level and the many complex issues that are facing physicians and patients in the year ahead.
In our conversation today with two of the AMA's leading health policy experts, we're going to look at a sensible policy solutions to address prior authorization hassles, Medicare payment reform, workforce shortages, scope battles, physician burnout and overall system dysfunction. And we're going to answer the all-important question, can anything actually get done in this fractured political environment?
The AMA believes it can. And through the work of our Advocacy Resource Center and our Advocacy team in Washington, DC, often in partnership with national, state and specialty medical societies, we are actively engaged with policymakers to create a health system that better serves the needs of patients and simply works better for all of us. So let's dive into the discussion.
Joining us today is AMA Senior Vice President of Advocacy, based in Washington, DC, Todd Askew, and also, Kai Sternstein, who commands our Advocacy Resource Center from Chicago. The AMA Advocacy Resource Center is the hub where we collaborate closely with national, state, and specialty societies to influence laws and regulations to help shape the health policy landscape. The ARC has a tremendous wealth of information and resources on all of the issues that we're going to discuss here today and recently released an inaugural State Advocacy Impact Report, which was shared at our State Advocacy Conference this past month. We'll put a link into it in the chat.
So until then, thank you, Todd and Kai, for being here. I'd like to begin with a big picture look at the health policy landscape in 2026. We're fresh off the heels of a successful AMA State Advocacy Summit, as I mentioned a moment ago, held earlier this month. And we're looking forward to advocating on the Hill at our National Advocacy Conference later this month, in February, later next month.
Building on this momentum, what are some of the key health issues that are emerging as top priorities for physicians this year? Todd, let's start with your national perspective on these issues.
Askew: Thank you, Dr. Aizuss. I think you hit some of it right at the top of your remarks. At the top of the list should always be a focus on the physician practice environment and the ability of physicians to provide quality care for their patients. So we focus on those things that get in the way of that.
Stable Medicare payments that keep up with the costs of inflation, reducing the administrative burden in the form of prior authorization and overly burdensome quality reporting requirements, supporting and protecting the appropriate role for all members of the health care team. Supporting the physician's personal wellness as well, is also critical to make sure that they are able to care for their patients. And of course, access to care, including access to affordable coverage for everyone is critically important this year. Especially in the light of the significant changes we saw enacted last year to the Medicaid program, as well as the expiration of the enhanced premium tax credit, it will create new challenges in the coverage and access arena that will bear a lot of attention, I think, this coming year.
Dr. Aizuss: OK, great. Kai, what about the state level, where are we seeing activity entering the new year?
Sternstein: Thank you, Dr. Aizuss and Todd. I really appreciate being here this afternoon. I think it's important to note that unlike at the federal level, at the state level, we have the luxury of operating in, what I call, 51 laboratories of experimentation. That includes all the state medical associations and the District of Columbia.
Currently, 46 states hold annual legislative sessions, while four states—I think a lot of people don't know this—Montana, Nevada, North Dakota and Texas meet biannually in odd numbered years.
So this year, we're expecting expansive legislative activity and regulatory activity in 46 state legislatures across the country and in the Council of the District of Columbia. And much like last year, I think we expect perennial issues to dominate medicines time and state legislatures. Every year, my team conducts a survey of medical societies across the country to identify the top issues that will define the upcoming legislative sessions, and we use those results to ensure that our resources are aligned with the priorities identified in medicine, and that we're ready to go, ready to do heavy lifting from day one of the legislative sessions.
Key findings from our survey looking forward into this year, into 2026, told us a couple of things. First, that scope of practice is going to top the legislative agenda for state medical associations across the country. This includes non-physicians seeking independent practice, prescriptive authority, and unsupervised diagnosis and treatment of patients being at the top of the list.
Number two, Medicaid policy pressures are intensifying in the United States, and in fact, 72% of our respondents indicated that they expect it to be deeply engaged in Medicaid policy, with priorities including physician reimbursement, funding, financial stability, redeterminations and coverage continuity.
And finally, I would say third, physician workforce challenges remain acute. This includes for the states looking at expanding residency positions, securing GME funding, resident retention programs, and alternative GME funding models. Of course, there's more. I'm sure we'll dive into that in the next few questions that you have.
Dr. Aizuss: All right. That's great. And it gives me a chance to also mention the fact that for our Scope of Practice Partnership, the AMA Board of Trustees, along with our new CEO, has increased the funding to $1 million to help on these legislative battles, as well as an additional $500,000 for specific projects and individual states. So, Todd, are there any specific legislative priorities that you believe will be especially critical this year?
Askew: I think one area to keep an eye on at the federal level, and it kind of reflects the national conversation overall, is affordability, and affordability and how that equates to access to care. We've already seen Congress begin to hold hearings and focus on the issue of affordability. One example just recently is the CEOs of some of the nation's largest health insurers appeared before two congressional committees earlier this—I'm sorry—I guess, it was late last week and really faced very sharp questioning on the affordability of health insurance premiums and how health plan consolidation and market power and vertical integration across health care sectors has impacted affordability.
There have been conversations already begun on pricing transparency and implementing some requirements that are already there and ramping them up, if you will, so that consumers can shop, if you will. They point frequently to the differentials between, for example, a colonoscopy at one hospital versus a colonoscopy at another, and the importance for patients to be able to access that information, again, tied to helping patients afford care.
There's continued scrutiny on the practices of PBMs and drug costs overall, and how that affects people's ability to afford their medicine. There's been a lot of focus on Medicare Advantage, looking at the fact that the government spends 14% more on a Medicare Advantage enrollee than they do in a fee-for-service enrollee. So all of these things, I think, are offshoots of the issue of the affordability of health care. And I think that is really going to dominate—remember, this is an election year, and the economy and the affordability issue is one that has received a lot of attention overall. health care is not exempt from that. And I think it bears watching anything touching on affordability very closely this coming year.
Dr. Aizuss: I think that's very critical. And you know AMA has been deeply concerned about both horizontal and vertical monopolies in health care, particularly with the insurance plans, as well as the PBMs. So how about the funding package that's currently with the Senate, after passing the House last week, where does that stand and what's included in it?
Askew: So that's actually a very good question. This was the remaining six large appropriations bills to keep the government funded and operating, and other items. It includes the Defense Department, Homeland Security, Labor, Health and Human Services, which funds many of the priorities that we follow very closely. The bill did pass the House, came over to the Senate, and then there has been a great deal of consternation with what is happening in Minnesota about the need for additional guardrails on the Department of Homeland Security actions as part of this package.
The House has gone, though. The House passed their package and left, and the government shuts down in a couple of days without this funding passed, or a large portion of the government does. So that is what the Senate leadership is struggling with right now. They cannot change this bill and have the House come back and vote on it without a government shutdown. And there are very bad memories of the record government shutdown we had just this past fall. So they are struggling to find a pathway.
Unfortunately or fortunately for us, one part of this bill that does enjoy broad bipartisan support is a significant package of health care provisions, as you mentioned. Many of them are extenders. They do it every year. They never get around to full reauthorization of some of these programs, but they extend it for another year. In this case, some of these things got extended multiple years, which is good because it provides stability.
And there were some other policy pieces in here, which had broad bipartisan support that had been part of that package at the end of 2024 that you might remember, that was a lame duck funding package that got blown up at the last minute after a lot of work went into building a consensus health care bill. So they resurrected parts of that package, significant parts of it, and included it in this bill to ride along.
And there were some things in here—actually, I know everybody didn't get everything they wanted, certainly, but there were some important priorities in here that we have very strong policy on that we have worked on for a number of years. There was a significant extension of Medicare telehealth provisions. Normally, it would only go for a year. This went for two full year—a two-year extension.
The incentives for physicians to engage in alternate payment models was not only restored with a 3.1% payment incentive for the performance year 2026, but also the threshold for qualifying for those payments was lowered from 75% down to 50%. So that's a significant advantage for those who are able to engage in those models and provide some resources to be able to do that.
You may recall that the Medicare Diabetes Prevention program, which the AMA worked on extensively in recent years, but one thing they never allowed to happen was that program to be virtual, where patients could participate virtually, rather than physically having to go to a program. That legislation was included to make that program virtual for, I believe, it was a three-year trial period to demonstrate whether or not that helps people with prediabetes prevent progressing to full-on diabetes.
There was a provision, for example, on Medicare Advantage provider directory accuracy. We frequently hear that the directories are so inaccurate that people will choose a plan based on a directory thinking that their physician is in that plan, but the physician is not in that plan. So there are some strong provisions that hopefully will be implemented in the right way that clean that up to make sure that those directories that patients are basing their plan decisions on are accurate.
On the extender side, for example, there was a five-year extension of the acute hospital care at home—hospital care at home program—pardon me. That is a very innovative program that grew out of COVID that is proven to be very viable in some cases to some systems. We're all familiar with the Dr. Lorna Breen Healthcare Protection Act, which has been critical in helping to implement efforts on physician wellness. We've been very engaged with the Dr. Lorna Breen Foundation. This program was extended through 2030.
There were PBM reform provisions, not as deep as we may hope for eventually, but there was maternal health provisions. The Preemie Act was included and more money for a state mortality review committee. So there was a lot in here that is tied up in this package. No major, huge victory, but a lot of small, really important programs got included in this package that staff has worked on over a number of years to try and pull together. And so we certainly hope that they're able to work out the differences regarding the DHS guardrails that they're looking for and find a pathway to make sure that the final appropriations bill that is enacted includes all of these bipartisan health priorities.
Dr. Aizuss: So it's great to see elements of what we've been working for years included in that bill. MedPAC recently came out with recommendation that we should have an increase in Medicare payment, but did not recommend an inflationary update as they had a year ago and as was in the bill that blew up a year ago. So there is no permanent Medicare Economic Index inflationary payment update in this current bill. And also, there's no extension, obviously, of the ACA subsidies, which has been highly controversial in the current Congress. Can you tell us what the AMA is doing now to work to address those two issues?
Askew: Sure. so I think you hit on the key word right there, "controversial." Because that is what keeps policies out of a package like this, unfortunately.
Permanent MEI for Medicare was never going to be a part of this package of mostly narrowly drawn policies and extender bills. Now, this is traditionally the package that would have carried a fix, if you will—the thing we dread every year, but have to have to prevent cuts—another one-year patch. Normally that would have been carried along in this package. But Congress included the fix for Medicare payments as part of the otherwise unfortunate bill that passed this summer that made a lot of Medicaid changes. It included a 2.5% Medicare payment increase in that package and so there wasn't the pressure to include anything like that in this bill.
Now, had this package extended all of the extenders that must be done every year for two years, instead of one year, meaning there would not be a lame duck session of Congress after the election, there was a chance that they would have included a second year of Medicare payment updates for 2027, because otherwise, they may not be able to come back to it. However, they did leave a number of extender items only with the one-year extension. And so we do expect Congress will have to come back and address this again during the lame duck session. And that would be the place that they address Medicare payments.
In terms of the advanced premium tax credits, as you'll recall, following the discharge petition, the House passed a three-year extension of the enhanced premium tax credits. That was forced by a Democratic discharge petition and did get a number of Republican votes. But in general, most Republicans in the Senate are opposed to extending this expansion that occurred during COVID and during the Biden administration.
There are a number of Senate moderates, if you will, who are still negotiating, trying to find a pathway forward. But even today, we're starting to get signals that the time for that to happen is coming to a close, that it faces—every day that passes, the chances of getting something done to reinstate those enhanced tax credits—and people need to—the tax credits don't go away. It's the enhanced tax credits that occurred that were expanded a few years ago. But that is looking like an uphill battle increasingly every day, despite a huge effort on the part of the health policy community to advance an extension for any amount of time. We'll see, but we should know in a few days, whether or not anything on that front is going to be possible.
Dr. Aizuss: OK. So, Kai, what do you see as priorities that are now emerging in the various states?
Sternstein: Thank you, Dr. Aizuss.
So in the survey that I referenced earlier, in addition to the top three issues that I identified, we learned a great deal of what else is coming our way. And it's a lot. Because we know, much like at the federal level, medicine doesn't have the luxury of focusing on one, two, or even three issues only. That's what physician leadership means. And we rise to the challenge every day here at the AMA.
So what came through for me and for my team is that for medicine, you've got medical licensure and telehealth continuing to be high priorities and public health pressures persisting amid political polarization. This is in addition to the three issues that I identified earlier.
And finally, I do want to note—or not finally, but I do want to note—that we heard three more things that I think are really important. We heard them loud and clear. First of all, states expect to work hard on the implementation of the One Big Beautiful Bill Act. We heard from our state medical association partners that they needed our help, as they expect the OBBA implementation to dominate their health committee's time in the upcoming legislative sessions across the country.
Second, we heard that payer practices continue to be a huge strain on physicians and their patients. Issues like prior authorization, network adequacy, claim denials, payment transparency will all dominate in the legislative sessions.
And finally, you've got AI and data and competition policy that are going to expand our collective agendas. A considerable number of states expect to work on AI and augmented intelligence policy, including payer use of AI. We also expect to continue to press on antitrust and competition issues, and then also data and EHR policy. So a lot on the plates for all of us at the state level this upcoming session.
Dr. Aizuss: We're going to have a very busy year at the state level as you always do. So for both of you, tell me a little bit more about how AMA Advocacy works. How's the AMA positioning itself to influence health policy, both at the federal and state levels, and how are partnerships with the Federation are key to our advocacy? Todd?
Askew: Sure. At the federal level, I mean, partnerships across the Federation are absolutely essential. And we hear this from policymakers all the time. What the AMA's power to convene means is that we can bring people's voices together. We can find compromise. We can find common ground, may not always find it, but we can try and find it, and identify policies that have broad support across medicine.
When we then go to Capitol Hill as a United Federation of Medicine, policymakers appreciate that. That's a major step that they don't have to take. Because otherwise, it would be 100 different groups with different provisions, different ideas trying to come together. And so when we're able to bring people together, find common ground, a common agenda, a common solution to a problem, it's a major hurdle out of the way for advancing some of those policies on the Hill. And it's just an absolutely critical tool for medicine as a whole to make its voice heard. And unity is really a key part of that.
Sternstein: Yeah, and I'll jump in there, Dr. Aizuss. The same thing, 100%, applies at the state level. I think that there are a couple things that position the AMA to influence health policy in a positive way. And the most important thing, the mantra that we live by in my team, the Advocacy Resource Center, is the collaboration and close coordination that we have with state medical associations and specialty societies on everything that we do at the state level.
Our state medical associations are the boots on the ground. We respect them immensely and trust them implicitly. We rely on their good judgment in terms of how and when we engage. All politics is local. That's our motto, and we get it. And we take our cues from the state medical associations. Sometimes, I think, it's frustrating for physicians out there to—they wonder, where's the AMA on these issues? And I can guarantee you that on the vast majority of issues at the state level, we're engaged with our state medical association partners.
We work in every single state. Sometimes behind-the-scenes because that's what's appropriate. It's not always appropriate and positive for a national medical association to come swooping into the state and tell state legislators what to do. We have to take our cues from the state medical associations, and it's why we have the success that we do.
I think, second, for us in the Advocacy Resource Center, one of the ways that we are positioned for success is that we operate as a true advocacy resource center. We create unique and evidence-based advocacy tools that help propel all of us across the finish line. We listen to what medical societies need, what their physician advocates say is missing, and we work pretty feverishly to create those resources needed to supplement on-the-ground work that I was talking about of those state-level lobbyists. So those resources include things like model bills and talking points and testimony and issue briefs and microsites and so much more.
And then finally, I'll say that the third leg of the stool for us is our ability to take up space where nobody else can really, in terms of our state advocacy. And that's advocating to national policy-making organizations that represent state legislators and state regulators in their work. Organizations like the National Conference of State Legislatures, the National Association of Insurance Commissioners, the National Conference of Insurance Legislators, to name a few.
We make sure that as those organizations produce their guidances, their model legislation, and whatever else they do for their constituents, where appropriate, we make sure that we are at the table, at their conversations, at their debates, ensuring that the physician voice is heard and taken into account as their policy process moves forward. It's a really efficient and awesome way for us to engage. Because with the National Association of Insurance Commissioners, for example, when they put out a guidance, it goes to all 50 insurance commissioners in the United States. And if we have our fingerprint on that and we've been engaged, we feel confident that what is being forwarded has our inputs.
And we share that with the state medical associations. And they come around the horn and reemphasize the points that we like, the points that we don't like. And it's this really well-coordinated, intensive effort that occurs. And without that, I don't think we would be as successful and positioned for success as we are.
Dr. Aizuss: So I think you both brought up an important point, which is the issue of resources and the ability to communicate, which gives me an opportunity to put a plug-in right now for AMPAC, which is important to our advocacy agenda nationally. And AMPAC is much more effective if all the physicians listening to us today would contribute. And same thing goes for the state PACs. I know that every state medical society has a Political Action Committee, and contributing to the state PAC for your individual state is critical to have access to legislators. So contribute to AMPAC, contribute to your state PAC. That is important so that we can communicate with our people in Congress, as well as our people in our state legislators.
So since we've been focusing on what was next, I think, it's also a good opportunity to focus on or to reflect on things that have occurred in the past that helped shape the future. So can you both tell us about a key victory or progress made in the past year that's going to help give us some momentum going forward?
Askew: Sure, I guess, I can mention a couple of things.
Last year was a very tumultuous year, very difficult year politically to get anything done in DC. But—and I may not feel this way, but the pieces continue to come together and point the right direction on Medicare. I know people are impatient, but we have seen some real commitment, new commitments, in the last year to—and realization of how critically important addressing this annual problem is in a permanent way. And I really do think that we will be able to build on conversations and ideas that were put forward in 2025 to improve our position in 2026.
Some of these things take a long time. Remember, enacting MACRA, getting rid of SGR took 13 years. So overnight success shouldn't necessarily be a given. But it should be a goal, and we should continue to strive to get this done as quickly and as efficiently as possible. But I think we're on a good—we are on a good path.
The second thing I want to talk—I'd mention is the really continuing, growing focus on prior authorization and other efforts that payers are undertaking, such as down coding and retroactive claims denials, to harm physician's ability to take care of their patients. You can bet, the insurance CEOs who are in front of Congress last week heard a lot about it.
The administration, as you may remember last year, pulled them all in and basically said, here are the provisions, here are the things you're going to implement. And if you don't do it voluntarily, we'll do it through regulation. There are already regulations on the book. And then we'll also do it through legislation. And there's already legislation out there that continues to have broad support to put some of these changes in statute.
Now, they're always going to find another way, another technique, but the momentum growing to address the big issues we see in prior authorization at the federal level also continues to grow. And so those are two longtime priorities that we do see continued momentum on and are hopeful that we'll build on those in the coming year.
Dr. Aizuss: I think we have a real opportunity on prior authorization. I did an interview with NPR on Monday, and I think that one of the questions they raised is they're hearing more and more about prior authorization, both in every state legislature, but they also are aware of our national efforts to impact prior authorization, as well. So I'm very hopeful on that, since that—in my own personal practice, I have 1.5 full-time equivalents devoted only to prior authorization, which is completely insane.
Kai, we've had some great victories this past year at the states. And we have a huge number, a huge amount of state legislation that we have to deal with every single year. And in spite of that, with the assistance of the ARC and your team, we've been very successful. Give us a couple of examples, which is going to give us momentum going forward.
Sternstein: Yeah, thank you for that. I have to reiterate, though, we are so lucky to have these 50 places to be able to operate. And it is thousands of pieces of legislation that are tracked by my team. But it is very different than what happens at the national level.
So as I throw down some of these numbers, I just want to make sure that I make that clear. We're talking about two very different dynamics happening. But I am really proud of my team, an incredible team here at the AMA, that works relentlessly for physicians and their patients at the state level.
And in 2025, we delivered 223 wins across all 50 states and the District of Columbia for physicians and their patients. And this is accomplished thanks to the tireless work of my team, but also the strong, strong collaboration that we have with our partners at the state level. And I'm not going to go through the 223 wins, that would be a little bit obnoxious, but at the highest of levels, I'll note three things.
First of all, we worked with over 35 states and over 10 specialties to tally over 95 scope of practice victories in 2025. And this included pushing back on pushes for independent practice by advanced practice nurses and surgery by optometrists, which you're very familiar with Dr. Aizuss, independent diagnosis and treatment of patients by pharmacists, and more.
We worked hard to pass prior authorization reforms in 23 states, where we pushed hard to eliminate barriers between patients and necessary care that, as we know, is sold by our insurer friends under the guise of controlling costs.
And finally, I want to note our incredible collaboration with the Dr. Lorna Breen Heroes Foundation that was mentioned a little earlier and others to ensure that physicians and residents and medical students are able to seek and receive care for mental health and substance use without fear of stigma and full confidentiality. In that vein, by the end of 2025, due to our work in this space and prioritization of this, we had 40 medical boards and over 1,800 health systems, hospitals, medical centers, clinics verify that their licensing and credentialing applications were free from stigmatizing questions.
I'm really proud of this work. And I am always wowed by this number, but this work alone has benefited over 2 million physicians and other licensed and credentialed health professionals. And it's incredibly important when it comes to physician well-being and burnout. So I'll stop there. I think that's enough.
Dr. Aizuss: So I think that's really great. And I think sometimes we as physicians don't keep in perspective all the victories we have. All we do is look at the things that we haven't been successful at. So I think it's really important to keep the perspective that we are very successful in spite of areas that we wish we were more successful at.
And the fact that we had 95 scope of practice victories, which is one of the concerns that I hear frequently in my conversations with our physician members, because they feel that their profession is being belittled. The fact that we have been pushing back on these non-physician providers and have won 95 times in the past year is extraordinary.
So we talked about our priorities. We talked about positioning. Let's talk about this in the context of the current landscape. What's possible this year in terms of movement on these key issues? Todd, you have faced, I think, the hardest job in Washington. It's like hitting your head into a brick wall and trying not to get cuts and scrapes and bruises continuously or let alone, a skull fracture. What do you think is possible this year in terms of movement on any of these issues? I know the obstacle we face is our highly partisan, divided government, but we do have a possible lame duck Congress coming up at the end of 2026, where there may be some opportunities.
What are you thinking of this coming year? Where do you think there's some hope for meaningful legislation passage?
Askew: Well, I mean, your point on the difficulty of getting anything done is just spot on. This has been a historically unproductive Congress by almost any measure. And there's reasons for that.
One is the margin, right? The Speaker of the House has about a two-vote margin. So basically, if any two people on his side of the aisle decide they're not for something, they can stop it and they can't move anything. It really paralyzes Congress to have basically a requirement of unanimous support on one side of the aisle in order to move any single piece of legislation, no matter how narrow.
You've also seen a really significant increase in the use of discharge petitions, where you will have some moderate, in this case, Republicans, joining with the majority of Democrats or all Democrats to force a piece of legislation onto the floor that the speaker or the majority may otherwise not want to deal with. Part of the reason that you're seeing that is because the political environment in the country. The upcoming midterm elections, which historically favor the party not in power in the White House, means you have a lot of moderate Republican members who are running for reelection or in states that Trump didn't win—there's only a handful, but there's enough—or that are facing redistricting—for example, in California—who are looking for ways to get votes and be on the record on some issues that may be more popular with their moderate base than the majority party. And so that just creates a chaotic situation.
Let's remember, the one big thing they did get done this year was the One Big Beautiful Bill Act. And they did that under reconciliation rules, which gives them vote protections in the Senate. But also, it unified them around—unified the Congress, or in this case, the president's side of the Congress, around their number one priority, which is extending tax cuts and then all the other stuff that was put on there. But all driven by preventing tax rates from going up.
And so other than that, it's been very difficult to move anything. But I think we look at the policies that were adopted as part of this appropriations package, these bipartisan health care policies, and we see that there is some hope, where you can continue to build momentum and agreement on more narrowly-drawn health care priorities.
There's also the opportunity in an election season, we talked about affordability. Can we focus on narrowly-drawn efforts to increase affordability, to increase access to affordable coverage, to give patients more control of their health insurance to put the patient and the physician back in the driver's seat? I thought you could hear it in the consternation of a lot of members who were grilling the health insurance executives last week, that I think there is maybe some possibility of moving some narrowly-drawn health care policy priorities, while continuing to build momentum for the big things. So I'm not totally pessimistic. I'm not ready to just give up and wait it out to the election. I think maybe there is an opportunity to do some good things in the health care sphere.
Then you mentioned on lame duck, obviously, it's really the worst way to govern, but it's a fact of life. And already people will be starting to put together a package of extenders and other potential policies for enactment in a lame duck session, where the political pressure is off a little bit.
We shall see. It's going to be a very difficult year given the temperature in Washington. I mean, the political temperature in Washington. And it'll take a lot of effort, a lot of unity, a lot of coordination and cooperation on the part of medicine, but we're not going to give up hope that there's some good stuff that can happen this year.
Dr. Aizuss: And Kai, are there any particular states that give us a particular opportunity to push through some meaningful legislation on any of our priorities?
Sternstein: Yeah, that's a hard question. You're trying to get me in trouble. And I'm not normally in the business of predicting this early, which states are going to have the greatest success. I will say it this way.
Our partners at the state level are incredible. Physicians have no idea how lucky they are to have the advocates that they have, the tireless advocacy that they have representing them and their patients in the state capitals across the country. I say this and I mean it. It's an honor to do this work and to work with these medical associations and their dedicated staff and the physician advocates that show up at the Capitol to tell their stories and to try to make change.
And it's my humble opinion. I'm optimistic that every state is poised to make meaningful impact on how health care is delivered in this country. My team and I are ready to be a part of that journey, part of that process. We're ready to help, whether we're asked to be the tip of the spear or to work behind-the-scenes. Whatever it takes to get victories for you and your colleagues, Dr. Aizuss, and your patients, that's what we do in AMA Advocacy, whether it's at the federal level or at the state level.
And we're here for it. We're ready to go. And like I said, I'm optimistic that we're going to have a lot of great success and we're going to have another great impact report to put out at the end of this year touting all the work that we've done collectively together to make a difference for physicians and their patients.
Dr. Aizuss: So I am starting to see a number of questions coming up on my screen from people that are in the audience. And I've already mentioned that one thing that physicians can do to support AMA's advocacy efforts and help drive meaningful policy changes to contribute to AMPAC. So I'm going to make another appeal for all of our listeners to contribute to AMPAC. Even if it's $5 to $10, it's better than nothing. And those who can afford more, there is—the people that are on the other side contribute far greater amounts than physicians do. So I strongly encourage you to go to AMPAC and contribute.
I also want to recommend that anybody who's interested come to our AMA's National Advocacy Conference coming up February 23 to 25. That's another great way that physicians can get involved.
And then, of course, it's very important that physicians join the AMA as a member if you are already not a member and become involved in your state medical association, as well. So those are all very critical things for physicians to do to support am advocacy efforts. Are there any other things that the two of you would recommend that physicians do to support AMA advocacy efforts to help drive meaningful policy change? And after you have responded to that, then I'm going to open it up and post some of these questions to the two of you.
Askew: Well, I would suggest, if you're not already a participant, to sign up for AMA's grassroot resources, the Very Influential Physicians program, or the AMA grassroots program, where we send out information and directly help facilitate your outreach and connection with your member of Congress. It's a great way—it takes minimal time commitment, but it's a great way to make sure that you're able to stay in touch with your members on the issues that are most important to you and to organize medicine.
And I would just say once again, on the AMA's National Advocacy Conference or for the State Advocacy Conference as well, those are so rich in content and opportunity to learn from other advocates, and also in the terms of the NAC, to participate directly in lobbying your members of Congress on some of these most important issues we've been talking about. So those are two things I would certainly highly recommend and encourage folks to do.
Sternstein: And I agree with everything that's been said. I would just add, I think, get engaged, whether it's White Coat Days at your state capitals, show up and tell your stories. I know physicians are exhausted and your time is tight, but it is so important for the physician voice to be heard, for your stories to be told, the impact of policies to be translated to the legislators that are making decisions, who oftentimes have very little health care experience.
And you cannot underestimate how important your engagement is. I think it's just absolutely crucial that physicians get involved in any way that they can. And that also includes figuring out who your state legislators are, reaching out to them, meeting them. Oftentimes, when they're at home, it's better than even in the State Capitol in their office, when they're conducting their official business.
Offer to be a resource. Hear from them about what concerns they have in health care and try to connect them with people who can help them figure out solutions. Develop those relationships. They will, over time, I think, result in great access and success for physicians. I think, no step is too small in that regard.
Dr. Aizuss: Well, that's great. OK, so we've got about 15 minutes left. Let's look at a couple of these questions.
Todd, what do you think's going to happen to patient access to care with the change in the federal subsidies for the ACA?
Askew: Well, I think, it's a huge challenge. And not only that, but the coming changes to Medicaid in future years as well is going to pose a challenge to access to coverage. Right now, the Marketplace—clearly about a million and a half fewer people, I believe, purchased insurance on the health care exchange this year for this current year than did in the previous year. And you would assume that a lot of those were due to the significantly higher premium costs many of them faced.
But I think the impact could get worse as we move forward, because many of these folks—A, purchased a cheaper plan, purchased a Bronze plan, for example, and they may found themselves now with a plan with a deductible that's so high, it's not a lot of value to them and their families. And they'll question whether or not they should continue to pay premiums for a plan that they really can't afford to use. And of course, preventive care is one thing, but I'm talking about when they're ill. So I think we may see some further diminution of the enrollment in ACA over the course of the year. I hope that's not the case.
But in Medicaid as well, the H.R. 1, the reconciliation bill, it didn't really change Medicaid eligibility that much, but it made it harder. It made it harder to get coverage and made it harder to maintain coverage. And that's why Kai and her group and other folks across the AMA are working really hard to provide resources and information to states and also to physicians, as they work with the state legislatures to impact the implementation of some of these provisions, because the states where that work's going to happen, to make sure that folks understand what they have to do to maintain their coverage, to make sure that legislators are informed of best practices when they are coming up with some of the implementation ideas. Best practices to minimize the number of uninsured that could result from some of these changes.
So there will be significant impacts. I don't think there's any doubt about that. But we can minimize those impacts if we all work together and provide that information, lobby the states, lobby our legislatures to enact these things in a way that is least disruptive.
Dr. Aizuss: So going back to you, Kai, now, one of the questions that was just posed is "How do we combat scope expansion efforts? Many states are trying to give independent practice to NPs and PAs under the premise that it will improve patient access. And I know that the ARC is accumulating data that is contrary to that in our effort to battle this scope expansion. But we're also hearing that there's a physician shortage and this is a way to ensure access. How do we respond to that?"
Sternstein: Well, thank you. This is one of my favorite questions. Because for us, scope of practice is probably one of our most well-resourced campaigns that we have, thanks to the support of trustees like you, Dr. Aizuss, and our CEO, Dr. John White. And the Scope of Practice Partnership that we formed, we'll actually be celebrating our 20-year anniversary of the formation of the Scope of Practice Partnership this year, which is a collective of state and specialty societies, and the AMA, the American Osteopathic Association and Osteopathic State Chapters, also, where we come together to make sure that we're all working collectively in the same direction on scope of practice issues.
We work in strong collaboration. Again, getting somatic from me, with state medical associations and the specialties to defeat that almost 100 bills that we defeated last year. We have a ton of resources on the access issue alone. This is a great example of something that my team does. So we heard anecdotally for a long time that these claims about solving access by expanding scope of practice, that it was just a bunch of malarkey that wasn't going to work. It wasn't happening that nurses and PAs and physicians and optometrists, ophthalmologists all work in the same area and that nobody—that the rural areas are complex, and we have a hard time getting people there, regardless of which profession you practice in health care. And so we realized really quickly, though, that anecdote and physicians saying that wasn't enough.
So we went after it. We tried to look at the evidence base, and we created our workforce mapper and our geopmaps that lay out the practice location of physicians by specialty, and then overlay the practice location of the non-physician providers to showcase what the state actually really looks like. This is an incredible resource, one of our most used resources, when it comes to scope of practice. And it completely cuts against the scope expansion of access arguments that the non-physician providers make. Because what those maps show is exactly what physicians knew to be true, that the practice locations, be it ophthalmologists and optometrists, almost mirror one another and are heavily loaded in urban areas. And then as you go out into the rural areas, things get more and more sparse and complicated.
And if you look at the history of these maps and you look at some states that have expanded scope, where the legislators decided that was a good argument, they believed it, and you look at what happened since the expansion, nothing. Nothing happened. Everything has stayed essentially static and the same. The numbers of nurses may have increased, but they overlay on top of the family physicians, the general practitioners, same area, almost identical when it comes to the urban areas, and again, kind of sparse and complicated for a lot of reasons in the rural areas.
So we create tools like that. We have so many more tools constantly pushing and pressing to create new, innovative things to get those victories. This is a critical issue for us. And we show up and we win, and we're proud of that.
Dr. Aizuss: So there's a question for Todd. One of the issues that's impacting both independent practice physicians, as well as those who are employed by systems, is the latest issue of downcoding and altering payment policies. So is there any opportunity that commercial insurers will face new federal regulations or legislative restrictions on non-payment, downcoding and/or delayed payment tactics in 2026?
Askew: No. I mean, we are seeing an explosion of this because quite frankly, you're having some success in limiting prior authorization in a lot of states, and so plans are turning to look to other techniques to limit coverage or limit payment to physicians. I mentioned, downcoding, also retroactive denials. They'll approve the PA, but then they'll come back and they'll deny the claim for some other reason later in the claims process.
I think there's three things here. There are limited tools that can be done at the federal level outside of addressing those practices and plans that are regulated by the federal government, such as Medicare Advantage. A lot of this falls on the state, and a lot of this is beyond the scope of the Feds, given ERISA limitations, as well.
And a good public shaming is always a good thing, as well. And the fact that we need to be calling out these practices by plans. People need to know what their plan is doing to try and deny them care or try and prevent their physician from being paid for the care they provided. The public needs to scrutinize whether or not this is a plan they want to buy coverage from or an employer wants to do business with another plan if they are engaging in these type of tactics. So making this information public, working with state regulators, working with other authorities that have a strong ability to influence some of these practices is absolutely critical.
We know in the prior authorization front, some of the new requirements are going to have public reporting on prior authorization denial rates and information that will essentially make us able to have a scorecard on these practices. And I think you'll see similar efforts on some of these other practices as people get the word out about some of these.
We talk to the plans frequently. When we hear from physicians about a particular practice that is going on or a payment policy that is planned, we reach out and engage directly with them. Sometimes, we're successful in convincing them that what they're getting into is detrimental to patient care, inappropriate, or otherwise not going to be positive for them, and sometimes, we don't, but we keep on trying and keep on calling them out and keep seeing limited success. But they're very innovative in finding new ways to get around new rules that are put up.
Dr. Aizuss: OK, I have a question for Kai. You know, the OBBA has resulted in massive Medicaid cuts. And also for those who attended the SAS, we did discuss there, how we will help states deal with these impending Medicaid cuts. But for those who weren't at the SAS, perhaps you can mention some of the resources and what the AMA is doing to help providers prepare for this massive change in Medicaid and Medicaid availability.
Sternstein: Yeah. Thank you, Dr. Aizuss. As I noted in the survey that we put out to the states, that was one of the things that came shooting up to the top, this expectation of engaging on Medicaid as a top priority and also, the OBBA implementation. Really critical issues for us. And the role of that the AMA can play in terms of convener, that Todd raised earlier, I think, is really important. And it's something that we do, I think, really well in the Advocacy Resource Center.
So we started last year convening state medical associations and hearing from them in terms of the issues that were rising to the top for them, what they needed from us. We're working with colleagues at Manatt Health also to get a broader understanding of where regulators are at the state level. They bring forward a lot of expertise to us.
And I think looking at 2026, we're going to be working with states very closely to mitigate the impact of a lot of these changes, as Todd brought up. We're going to be providing resources and webinars that highlight opportunities for policy changes. We're looking at providing patient-centered resources. Also, we're in the process of creating those for physicians to be able to have for their patients to help mitigate some of the harms.
We're going to be looking at issues in terms of marketplace changes and challenges and what physicians can do to help provider taxes. We're looking at the work requirements and—I'm sorry—the work requirements—there's just so much. There's this long list. But all these issues, we've got a series of conference calls that we're having with our state medical association lobbyists. We're hoping that we can provide a place where they can share what's working and what's not. And we're considering possibly like even bifurcating calls based on region or type of state, because different issues arise in different states.
And so there's a desire to not have to reinvent the wheel. Our resources are limited. And this is a really, really big lift for medical associations. And so we're putting everything that we've got into this in terms of creating the issue briefs and the resources and the patient tools and the webinars.
We've got a microsite that's private, a SharePoint site, that we have our state medical associations have access to where we're putting all of the resources that we're creating, where we're allowing them also to share their resources. Again, a little bit modeled off of some of the other campaigns, the Scope of Practice Partnership. When states do something really good and it works and it's clicking, other states need to know about it so they can then adapt it to their state and go forward and not have to start from scratch and reinvent the wheel.
We're going to be doing a lot of work with patient organizations also and trying to help bridge and create some collaborations there and coalitions there for state medical associations, also. So a lot of work to be done. We expect that this is going to be a really big part of our 2026 agenda.
Dr. Aizuss: All right. Well, before we close, I've got one question, which I think represents a misunderstanding of what we actually do that Todd can mention. So the question says, "The AMA has been deferential to the current administration and as a result, we have been silent about vaccine changes and current HHS, ACIP and other leadership changes. Will the AMA be more vocal in 2026?"
My opinion, this is a misunderstanding of what we're actually doing, and we've been quite vocal this week alone. We put out statements in response to the suggestion that they should get rid of the polio vaccine. We put out a statement in response to what's going on with ICE in Minnesota and the impact on health care and health care facilities. But I think we will be more vocal and are being more vocal.
Todd, do you have anything you want to say in response to that?
Askew: I would add, we also put out a statement supporting the American Academy of Pediatrics vaccine schedule, as opposed to the changes that have been suggested by the administration, the more limited set. We're not always going to agree, and we will be vocal, and we will be truthful. We'll talk to the administration and tell them directly that we just—this is something we're not going to agree on. But I think people need to not have it in their mind that there's nothing that we can agree on. There are things we can work together and we have to work together with the administration on. And so we shouldn't let just our disappointment or disagreement on one set of issues color our ability to influence what they're doing on another set of issues.
So it's about sticking to the science. I agree with that 100%. It's about being forthright and straightforward and saying where we disagree, we're just going to disagree. And I think we did that this week with the vaccine schedule. And as appropriate, we'll do it in the future.
Dr. Aizuss: So I think that gives us—we're at the end of our time. I want to thank our audience for the great questions. I want to thank Todd Askew and Kai Sternstein for being incredibly effective and for engaging in a wonderful conversation.
As I mentioned, the AMA Advocacy Resource Center is on our website. It's the place to find resources, data points, model legislation, white papers and a lot of other material that can support you and your advocacy efforts at home. And I hope everyone takes advantage of that resource.
Again, please join AMPAC. Please join your state PAC. Get involved in the American Medical Association. If you're not a member, please join if you haven't already. And if you haven't joined your state medical association, join your state medical association, as well. There is so much that we can accomplish with increasing our membership and increasing our contributions to both AMPAC and our state PACs. We need to be involved. We need to impact the health policy issues that affect physicians, patients and our entire health system.
Thank you all for tuning in this afternoon or an evening, and I'm looking forward to having future conversations with both of you.
Sternstein: Thank you.
Askew: Thank you. Thanks a lot.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
