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Featured topic and speakers
How do we fix the health care system for doctors? What policies does the American Medical Association support? What's going to happen to Medicare?
Our guest is Todd Askew, senior vice president of Advocacy at the American Medical Association. AMA Chief Experience Officer Todd Unger hosts.
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- Fixing prior authorization
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Speaker
- Todd Askew, senior vice president of Advocacy, American Medical Association
Transcript
Askew: We have a great team and great partnership with the states and with the specialties. And I think, as long as we just keep our head down and keep grinding, we're going to make progress on those issues that matters most to physicians and matters most to patients.
Unger: Hello and welcome to the AMA Update video and podcast. Well, it's empty now. But we're here on the floor of the AMA House of Delegates. And soon, this room is going to be filled with physicians, residents and students here to talk about health policy.
And to kick it off today, we're going to talk with AMA's Senior Vice President of Advocacy Todd Askew, and get an update on AMA's advocacy efforts and talk about our priorities for the year ahead. I'm Todd Unger, AMA's chief experience officer. Welcome, Todd.
Askew: Good to be here, Todd.
Unger: It's great to see you. We got a lot to talk about. Why don't we just kick it off by talking about what everybody is talking about in Washington right now, which is the budget reconciliation bill. Why don't we just start by getting a preview of the latest news on that?
Askew: Well, as you know, the bill has passed the House and gone over to the Senate. We started out with some possibility of some benefit cuts and some funding cuts in Medicaid. The worst things did not come to pass. But unfortunately, there are still some pretty significant Medicaid provisions.
CBO, just in the last couple of days, has come out with projections that almost 11 million people could lose their health insurance because of those provisions. So we are continuing to work and encourage folks to reach out to the United States Senate to talk to their members about the impact that that will have on the ability for not only patients to maintain good health, but for practices to remain sustainable, the impact on hospitals and nursing homes and other providers.
It could be pretty significant if those cuts come to fruition. And unfortunately, it's not even as much about cutting, as we said, benefits or eligibility, a lot of the provisions actually just make it harder for people to get coverage for which they're eligible or to maintain that coverage. And that's where some of the savings comes from. So we really need to see some improvements there.
We did, though, have some positive news on the Medicare front in that they included, for 2026, Medicare update of 2.25 percent approximately, which is 2 full percentage points above what's in current law, and then tying future updates to the Medicare Economic Index, not at the level we would like. So even our staunchest champions agree that we're going to continue to need to work in future years to increase those updates. But it's the first time in two decades that we've had some tie to the actual increases in cost of providing care in the formula.
And lastly, another area of concern in the bill is the impact on student loans. There are some changes in the student loan program that would cap the amount of dollars that students could borrow, as well as their eligibility for Public Service Loan Forgiveness, which will unfortunately, negatively impact medical students, given that the caps fall well below the total cost that most medical students encounter in financing their medical education.
So a lot of work to do, a lot of challenges in moving the bill forward. But it's a long process that will play out again over the next few weeks. And we're fully engaged. The physicians are fully engaged through the grassroots program. And we're hoping to see continued improvement in this bill as it moves forward.
Unger: So the House passed this. It's now gone to the Senate. Kind of, what can we look forward to over the course of these next few weeks?
Askew: Well, I think we're starting to see changes rolled out by the various committees in the Senate. Some committees perhaps will have markups, some committees may not. I think the Senate majority leader is leaving it up to the committees to decide how they would like to proceed.
Conversations are obviously going on with the White House. The president is very engaged in rallying the Republican members. This is a purely partisan exercise. The Democrats really are going to be against whatever comes out. So they're trying to just get the number of Republicans they need.
There are people who feel the bill goes too far, and they want to see it moderated. And there are people that feel the bill doesn't go far enough. And they want to see bigger cuts imposed on various programs. And so that's the challenge the majority leader is going to have and the president's going to have in trying to bring them together to form some sort of consensus.
And even if they can get there, then they have to send it back to the House, where it only passed by one vote. And so anything they do in the Senate that upsets the balance that the House struck is going to be an issue for going back to that body. So it is not an easy path for them.
That's the way the system was designed, though. When you're in a partisan exercise like reconciliation, there are very strict rules they have to adhere to and the processes constrain what they can do. And so it's a long road they have ahead.
Unger: And we'll keep everybody updated, of course, as things roll out. Not the first set of changes here for medicine. There have been a lot of changes over the past five months. Talk to us a little bit about how your team and physicians have been reacting to all of the changes that affect medicine.
Askew: Well, it is a torrent of changes, as you alluded to, not only with the legislative challenges on Capitol Hill, but the volume of changes being proposed by the administration. Just within the last week, the formal budget proposal was rolled out with an enormous amount of change for the Department of Health and Human Services and including a lot of cuts.
The proposed budget cuts funding by basically a quarter across all of HHS. NIH is cut by 40 percent. There's significant reorganization at NIH. They're going from 19 institutes down to eight through consolidation and a lot of refocusing of what the research priorities will be.
They've created a new Administration for a Healthy America. And they are consolidating into that HRSA, CDC, SAMHSA, all rolled into this new agency, which will be the primary vehicle to focus on wellness and prevention. And dozens and dozens of programs that all have constituencies are being eliminated or proposed to be eliminated in this budget.
So it's a struggle just to keep up with how many changes are being proposed. But we are engaged very closely, both watching what the administration is doing and talking to Congress, because Congress is going to have a say. The appropriators are going to be the ones to say, are we going to fund this new department or new organized department in the way that the administration would like? Or do we as Congress have the ultimate say in determining what programs we create and that we fund?
So there's that tension going on right now that's really going to be something we've never really seen, I think, in this country, at least not in our lifetimes, this tension between the administration and Congress over, who has the ultimate authority to create and fund and operate these programs. And so we are constantly engaged in trying to analyze and put our views in on what direction some of these programs are going in.
Unger: It's just so much uncertainty. But given what you just said, plus the ground shifting, how do you balance something like that in the macro environment with the priorities that we have?
Askew: That's really important because emanating from this House of Delegates, this is where our priorities come from. This is where our policies originate and we're tasked with going forward. And so we have to really stay laser focused on those things that this House, that our membership, our board has designated as the most important priorities affecting medicine.
And I think based on polling we do and doctors we talk to, I think we have those priorities right. We know that physicians are concerned very much about Medicare payment rates. They're concerned about administrative burdens like prior authorization. They're concerned about scope of practice.
They're concerned about the digital environment and the challenges they have in adapting to new technologies. And also, the overriding theme, of course, is physician wellness and burnout. And all these challenges coming at all of us, what does that do to the physicians ability to take care of themselves and so that they can take care of their patients.
And so that's where we try and focus. But there are a lot of distractions. And there are things that have to be tended to as well. So it is, as you said, it is a challenge.
Unger: Let's dig into one of those topics that you brought up there. The term "prior authorization," I never thought I would see that enter the public lexicon in the way that it has recently. It's a problem that affects everyone, from congresspeople that we've talked to, to everyday people, they're all experiencing, but this burden that then gets placed on the physician has been very destructive to well-being, for instance.
Askew: No, it's an incredible burden on physicians and their practices. It's an incredible burden on patients who sometimes are left to wade through these difficult processes themselves. It's a cost to the entire health care system, including to payers.
And it's difficult to understand how the time and effort spent on prior authorization—I mean, obviously it makes sense for some payers. But I will say, we're starting to see, given the groundswell across the country about prior authorization and the burdens, we're starting to see payers begin to realize that this is not the way the health care system should operate. You shouldn't have to fight to get coverage that you've already paid for, that your premium dollars fund.
And so I think we're going to make some real progress. The new CMS administrator, Dr. Oz, in his confirmation hearing, really made some wonderful points about prior authorization, the need to get the volume down of prior authorization requests, the need to limit the scope and the number of procedures and other things that are subject to prior authorization, the need to address continuity of care, to make sure that prior authorization is not disrupting the relationship and the ongoing care needs of patients.
And so I think between the rules that are already in place and being implemented, the interest of the administration in prior authorization, the public's attention to this now, as well as some legislative proposals—the Seniors Timely Access to Care Act has been reintroduced in both the House and the Senate now, with a growing number of co-sponsors.
I think we have a real opportunity, again, more so than ever before, to make substantial progress in lowering the burden put on folks in the system by prior authorization.
Unger: All of that progress that you just talked about, it's such a great example of how organized medicine and the AMA can make a huge difference in this space. An additional priority that we're working on, of course, is around the subject of scope of practice. This is something that physicians care deeply about.
Our position is about physician-led, team-based care. There's activity at the federal level, activity at the state level. Tell folks about what's happening right now.
Askew: So you're absolutely right. And that's what we're all about, where everybody has a critical role to play in the health care system. But physicians are the captain of the team. And ultimately, physicians are responsible for the care provided to their patients.
And so we take these challenges very seriously. A lot of this is fought in the state level. And in our partnership, through the Scope of Practice Partnership with specialties and with our state partners, and working directly with the state medical associations, we've really taken this on. Probably every state in the country has engaged in scope issues. And you're not always successful.
But we are highly successful because when we go to the states, and we talk about, this is not about legislation, it should be about education. It should be about qualifications. And it should be about the primacy of the physician.
And patients want physicians—we know patients want physicians involved in their care. And so we go through those battles every year. But you mentioned at the federal level, we are seeing an increasing number of efforts to impact scope issues at the federal level.
And it's important that we continue to counter those because ultimately—and I think this resonates—it's about patient safety. It's about focusing on what the patient wants. And we're right, and I understand there's some frustrations with some of the other non-physician providers. But they tend to be more frustrations with the system, probably frustrations that we all share. But we are constantly vigilant about the need to protect the primacy of physician-led care.
Unger: And that, again, another great reason to support the AMA, your state societies, your specialty societies, because we are dealing with just a torrent of issues around that, again at the federal and state level. Todd, anything else you want to share in terms of insights from the Hill or the activity of the AMA Advocacy team before this big meeting kicks off?
Askew: I think that there's a lot going on. And sometimes, it feels like, well, why aren't we doing this? Why aren't we doing that? We got to be everywhere. But you can't be everywhere all at once. But we have our focus. We have our priorities. We have the right priorities.
We have a great team and great partnership with the states and with the specialties. And I think as long as we just keep our head down and keep grinding, we're going to make progress on those issues that matters most to physicians and matters most to patients. And so we're excited to hear what the House has to say and to hear the direction that they want us to go in and are just looking forward to a great meeting.
Unger: Todd, this has been a great conversation. I'm sure everybody out there appreciates all the insight and, of course, all the work that you and the AMA Advocacy team are doing to protect physicians and patients in this uncertain environment. To support the AMA's advocacy efforts on the issues that we talked about today and all the ways that we're fighting for physicians, we encourage you to become an AMA a member at ama-assn.org/joinnow.
That wraps up today's episode. And we'll be back soon with another AMA Update. So be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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