AMA Advocacy Insights webinar series: AMA advocacy priorities with a new administration and Congress

With a new administration and new Congress taking the reins at the start of this new year, how is AMA advocacy positioned to effect change on the key issues facing patients and physicians? What opportunities and challenges lie ahead, and how can physicians get involved? 

Watch this AMA Advocacy Insights webinar to hear the latest, and get a sneak preview of the upcoming AMA National Advocacy Conference in February.  

Moderator

• Bruce A. Scott, MD, president, AMA 

Speakers

• Todd Askew, senior vice president, AMA Advocacy 

• Jason Marino, director of Congressional affairs, AMA Advocacy

Dr. Scott: Good afternoon or good morning, wherever you are. Thank you everyone for joining us in this latest in our AMA Advocacy Insights webinar series. I'm Dr. Bruce Scott, the president of the AMA and an otolaryngologist in private practice in Louisville, Kentucky. 

Today's webinar will take us inside the AMA's top federal advocacy priorities as we begin 2025 with a new administration and a new Congress. Whenever a new team of policymakers arrive in Washington, DC, it creates opportunities for us to educate and influence their understanding of how the deep-rooted flaws in our current health care system are impeding our patient care, threatening the viability of our practices, and driving physician burnout and dissatisfaction. 

At the top of this list is the financial pain we continue to endure, despite our broken Medicare payment model that has actually cut physician reimbursement by over 33% since 2001. And that includes a devastating 2.8% cut starting just a few days ago, January 1 of 2025. 

This marks the fifth consecutive year that payments to physician practices have been cut, despite the inflation and the surge in practice costs that all of us have experienced in these last few years in particular. 

These annual cuts ripple across health care, forcing physicians to make difficult choices to limit the number of Medicare patients they see, perhaps to stop seeing new Medicare patients altogether, or in some cases, close their practice. 

All of this jeopardizes the access to care for millions of Americans, particularly our most vulnerable patients, our elderly and our disabled patients. This is simply unconscionable, and it demands immediate action from our Congress. 

Now, the good news is that sustained pressure from the AMA and advocacy on this issue over the past two years has laid the groundwork for long overdue reform. Policymakers on both sides of the political divide now recognize the serious impact these cuts have been having on access to care. 

And they have pledged to fix the broken system by reversing this year's cuts and even more importantly, by enacting a new payment formula that is based upon the ever-growing cost of providing care. 

But we're not there yet, which is why we need physicians from every state, from every specialty, all of you listening today and all of your colleagues to continue to apply pressure on Congress through our fixmedicarenow.org website campaign. 

Last year, this campaign generated over 500,000 messages to Congress. And now they're finally listening. Our special guests today will share the latest on that campaign and how we're leveraging the power of a unified physician voice on this critical issue. 

Our conversation this afternoon will explore the latest on the AMA's push for Medicare payment reform, our chances of success in 2025 and also highlight other federal advocacy priorities, including prior authorization and addressing the key drivers of physician burnout, scope of practice, and dissatisfaction at the system level. 

Each of these issues is so important for health and long-term sustainability of our health care system, and most importantly, for the access to care for our patients, which is why we wanted this to be our first Advocacy Insights conversation of the new year. 

Joining me today is Todd Askew, AMA's senior vice president for advocacy in Washington, and also Jason Marino, the AMA's director of congressional affairs. Todd and Jason, thank you both for joining us. Let's dive right in. 

Let's start with you, Todd. Let's start with a big-picture overview about how the AMA advocacy works, what it's all about. And if you will, tell us how policy is set for those of us who are beginners and how our team advocates. And perhaps talk about what AMA advocacy is not. 

Askew: Well, thanks, Dr. Scott. Good to see you. Thanks for having us. First of all, as most of you know, I think, AMA policy is developed by the House of Delegates, which brings together the voices and the views of state medical associations, as well as the national specialty medical organizations. 

That really provides us with a really robust foundation that informs what our priorities and policies are, some direction to many of our efforts. But advocacy, as we know, is most effective when it's grounded in that substance, but also in timing and strategy.

So policy alone does not equate to strategy. Policy alone is not advocacy. Policy is directional to that strategy. And to be effective, what we try and do is we take advantage of opportunities and advance those opportunities when they present themselves. 

When we have a chance to move something, to make progress, that's where we put our efforts. That's where we put our resources. Advocacy is not just screaming into the wind about everything you might have policy on, because we literally have thousands of policies. You have to pick and choose not only what is most pressing, what can be most impactful, but what can we literally make some progress on. 

And so that's what we do. We prioritize where we can achieve progress informed by that policy. And we do that by leveraging the voices of physicians. We do that by leveraging the voices of patients. We do that through unity across the Federation of Medicine and working in collaboration with other medical organizations on those things where we have a lot of common ground. 

And it's also offering solutions. Anybody can go to talk to your policymakers about problems. We can list out dozens and dozens of significant problems, as you referenced with the health care system today. But that's not enough. 

It's about coming up with creative, innovative solutions and then working with those policymakers to implement it. And that, in a nutshell, is what advocacy is and how the AMA goes about it. 

Dr. Scott: Well, that lays it out really nicely. Now let's bring us up to the current political landscape. We all know there was a recent election and a recent inauguration. Can you tell us about the makeup of the 119th Congress and tell us about this administration? And focus on potential opportunities and challenges facing medicine over this next year. 

Askew: Sure. So we're at actually a pretty unique situation. Coming out of the last election, the Republicans won a trifecta. And what we mean by that is they not only control the White House, but they control both chambers of Congress. 

And so while the president certainly is going to have a very strong influence over the direction Congress will take, the margins, especially in the House, are really very thin. 

That means to pass legislation, essentially—especially the reconciliation bill, which we're anticipating, which is a technique to avoid a filibuster in the Senate—the Speaker of the House is going to have to put together a legislative package that can win the votes of essentially every single Republican member of Congress because there would literally be a one-vote margin. 

Only one Republican can vote no. And on something like a reconciliation bill, it's only going to really be Republicans. So that's going to be a huge challenge, even with the advantages provided by reconciliation in the Senate, to pull together that piece of legislation that not only achieves what they want to achieve, but does so in a way that can earn the vote of every single member. 

Now, that means, going through the year on other legislative efforts and legislative of priorities, it's going to be really difficult to pull together that 100% Republican support. So there's going to have to be a degree of bipartisanship on any piece of legislation beyond reconciliation that is going to move in this Congress. 

And that is something that we've always done in our advocacy. We have always prioritized bipartisanship. In fact, I think almost every single piece of legislation we have supported in the last several Congresses has been bipartisan, because we try and grow that support from the center out and find pieces of legislation, find those solutions I referenced that we can build support on from both sides of the aisle. 

And I think that in the environment we're going into, which is a very difficult environment right now in Washington, it will settle down. They will find their pace and begin to govern. But finding that bipartisan support in the long run, I think, is going to serve us a lot better in advancing some of our priorities. 

Dr. Scott: Well, certainly, there are a lot of priorities facing medicine right now. And from the American Medical Association, one of our top priorities is this Medicare fix. So, Jason, let's go to you. 

I know that the AMA's National Advocacy Conference is coming up in less than a couple of weeks, where hundreds of physicians will gather together on Capitol Hill. And we're going to need to tell Congress to fix Medicare now. 

Can you tell us more about the Medicare ask, about the message itself and what we need to deliver to our lawmakers to be successful? 

Marino: Thank you, Dr. Scott. Thanks for inviting me. Let me start by saying, let's go back to the 118th Congress. It didn't end in a way that we had hoped when President Biden signed into law the American Relief Act that pushed out government funding until middle of March. An earlier version of that bill had a 2.5% relief. 

Of the 2.8% cut you mentioned, 2.5 of that would have been wiped out. But that didn't make it at the last minute. It was chaotic. They had the bill—essentially, negotiations collapsed. They went to a skinnier package. 

And here we are in January with a 2.83% cut, fifth year, as you said, fifth year cut in a row. And I understand that the audience here is very deeply frustrated with this and with the history of the Medicare payment system. And what do we do? 

Well, we do—Todd mentioned a strategy. And I do have some good news to share, some optimism, in that this Friday at 10:00 AM, we're going to have a bill introduced, a bill that would wipe out the 2.83% cut and that would give a 2% update, payment update in 2025.

This bill will be introduced by Congressman Murphy, Dr. Murphy, Congressman Panetta, and five Republicans, five Democrats on Energy and Commerce, on Ways and Means, 10 members. It's going to be called the Medicare Patient Access and Practice Stabilization Act of 2025. 

And it would have been introduced earlier this week. But we're trying to get—all 10 members wanted a press quote, how important this bill is. And so trying to navigate that takes some time. But 10:00 AM on this Friday, it will be introduced. And that's the first step. 

The ultimate strategy is, in March, they're going to have to come back. There's a lot of chaos right now, as Todd mentioned, a lot of bills, a lot of things happening. But March 15, the federal funding for this current year expires, and they have to pass a bigger package. 

And we are using this bill that will be introduced Friday to help position ourselves in the best possible way to be in that package, to reverse as much of the cuts as possible, to try and get an update. And it's a situation where it's not just going to happen automatically. 

The audience on this call and this webinar is going to be critical for that. And I just want to give an example of—I recently read this book twice by Morgan Housel called The Same As Ever. And it's about things in history that stay the same. 

And one of those is that the best story always wins. And if you just look at that history, for example, the Wright brothers—there was Samuel Langley, and there was the Wright brothers. They were both trying to race to who can fly the plane first. 

Langley had all the experts and the money and the connections. The Wright brothers just had a bicycle shop and fierce determination and no real money. But they had a compelling story. And at the end of the day, I had to look up, "Who is Samuel Langley." It's all about the Wright brothers. They won. 

If you look at—during the Great Depression, look at FDR. There are horrible stats about 25% unemployment. He didn't just cite stats. He talked about a farmer. He talked about an unemployed worker. He made it personal. He moved the New Deal through Congress on stories, not just horrible stats, but gave some hope. It was compelling. 

Look at Steve Jobs, 2007. There was the iPod. Then he introduced the iPhone. And he didn't just talk about how it was different than the iPod or the BlackBerry. He talked about how it's going to revolutionize our lives and how we communicate. 

It was riveting, and it was an instant phenomenon. And look at it now. And we need to do the same thing. We need to give Congress a reason to care about these cuts. And we need to tell the story about the rural practice on the verge of closing because of these cuts, and they can't afford to see Medicare patients. 

I've heard some stories from physicians that aren't even taking a salary. They're keeping the practice open by not taking a salary, because the Medicare payments are going for their staff and technology and innovation. They're not getting paid. But that's not sustainable. 

And that story needs to be told about what that means in the real world for you and your patients in a way that's compelling in the real world. And we have an incredible site, fixmedicarenow.org. 

We have graphs that show the story about the loss to inflation for physician payment of 33% since 2001, the five years of cut, how every provider in Medicare gets updates except physicians. Those are great stats. They help. 

But you need the story that drives the narrative that sticks in people's and members' heads and gives them a reason to care in this time when they're getting hit at all angles and all their other issues. And that is so important. 

And it all does start, though, with having a good bill to rally behind. And I'm very hopeful that the Advocacy Conference couldn't be better timed to have all physicians, leaders coming to Washington to be in the Capitol at the historic Cannon Caucus room with—and we got seven members of Congress. 

All the champions on this bill I just mentioned are going to be there pushing for this bill, saying how important it is. And then at the Grand Hyatt, at the NAC event, we have a list of members of Congress that are going to speak there. And they're all going to go to the Hill with the stats and their stories. And I'm optimistic that we're going to move the needle on this. 

Dr. Scott: Jason, as I travel around the U.S., I listen to the stories of physicians struggling, closing their practices. And I can tell you personally, two of my partners are leaving practice as of the end of this month to join a hospital, because private practice can no longer support the level of income that they need to pay all their bills. 

One of the things I think that we need to make clear in our rhetoric to Congress is that all we're asking for is something that sustains us at our current level. This is to pay your increased expenses. In effect, not a dollar of this would go into the doctor's pocket because what it's going to go into is our increased cost of our lease, our staff, our energy, everything else that we buy. 

So we're already getting a lot of questions coming in. And the first one, Jason, I'll send back to you, Dr. Ray Callas from Texas asked, are you working specifically with the doctor caucus? And who are our other champions on this? 

Marino: Yeah. So we have this bill that I mentioned. We have Dr. Murphy, Dr. Joyce, Dr. Reeves, Dr. Schrier. We have Congressman Panetta. We have new champions now. We have Congresswoman Carol Miller from West Virginia. We have Claudia Tenney. We're growing it. 

But the doc caucus on both sides, the physician members of Congress, are fired up, understandably. And we're fortunate that we've developed these 10 members that are going to go out there to their leadership on the Republican and Democratic side and say, when this package comes together, we cannot leave these physicians and their patients behind. 

And we will not vote—we cannot support a package that leaves them behind like we did in December. And they're fired up in a good way, and they're champions. And we're lucky to have such a good group of champions. But they're highly engaged. 

And we're going to build it so it's not just the physician members. We're going to go all the way into—just today, the chairman of the Senate Finance Committee, we've been very engaged at the RFK nomination. He opened up. He mentioned the broken payment system. He's the chair. He gets it. And we have his support on this as well. 

Dr. Scott: So we're getting a bunch of follow-up questions that are coming in. They want you to tell us the name of the bill again and if there is a number yet for the bill and specifically the sponsor. A number of people already are interested in contacting their representatives. So go ahead, Jason. What was the name and number of that bill? 

Marino: Sure. So this is the bill that will be introduced on Friday at 10:00 AM. And it's the Medicare Patient Access and Practice Stabilization Act of 2025. Once it's introduced, after a couple hours, the clerk of the House will give out a bill number. And we'll distribute that widely. 

I'll also say we have in the queue ready to go a draft letter that we intend to circulate to all the state medical associations and all the specialty groups supporting this bill. And it would go to the Congressional leadership and the House and Senate saying these cuts have to be reversed. Here's this bill. We encourage you to advance. 

And then we need to get to a place where we have permanent reform. But that letter will be circulated as soon as we have a bill number sometime Friday. 

Dr. Scott: Can you give us a little more detail on the bill, an individual asked. Does it actually specifically mention and link to MEI? For those who don't know, that's Medicare's estimate of the increased cost of care each year. And Medicare, for 2025, estimated that that would be 3.8% up, meanwhile, a 2.8% cut, 3.5 up, 2.8 down. 

Is the new bill—does it mention MEI? And is that specific in the legislation? 

Marino: So the new bill, one key feature is that it's going to be prospective in that it's going to be from April 1 on. They're not going to try—because we all—we've heard it's difficult when you go back and try and process claims you've already made. So it's going to be the equivalent of reversing the entire cut and a 2.5% payment update. 

It's not—MEI should be 3.5. So it's partial. It's partial MEI at 2%. And we're also trying to be realistic. It's a difficult climate. We're facing cuts right now. And it's going to be a lift. And we're going to really try and push to get the full payment, try and get a payment update for 2025. 

But it's not going to be easy. And it's going to take everyone firing on all cylinders, pushing for it. And we're also trying to pivot so that when we go through this exercise, we can then pivot to we need to once and for all, get a permanent MEI update. 

And this helps us—this is the process of building support is the first step, though. Can't be getting cut. We have to stop those cuts and then get to a place. 

Dr. Scott: Well, and Todd, let's turn to you for a moment. Can you give us more information about the sort of comments and discussion that people should have with their legislators that will help support this bill? 

Askew: Well, I mean, I think Jason referenced it in his earlier comments. You got to tell your stories. You have to take it home, not that some theoretical percentage of an increase in a payment—it's got to be about how this impacts your ability not only to continue to care for Medicare patients, but to pay your staff, to pay your rent, to be able to keep the doors open in your community. 

Folks, these dollars—and you referenced it, Dr. Scott—these are not dollars going into a doctor's pocket. These are dollars going into employ their constituents or to take care of their constituents and their voters. 

And really to bring it home about how these dollars impact, if you show that one chart—when you show them the chart—we call it the Gap Chart—that shows the 30% difference over the last two decades between medical inflation and Medicare payments, people can't believe it. 

They don't understand how physicians can still be in business, having fallen that far behind inflation. And so talking about how that impacts your ability to continue to care for your patients, what's happening with your partners, having to make decisions, not because they necessarily think it's the best way to practice medicine, but because they have to financially. 

That's not how we need a health care system to work. And so it's always—as Jason said, it's about the stories and making sure they understand how it impacts their constituents in their community. 

Dr. Scott: One of the other messages that I think has been compelling is to point out that physicians are the only group that doesn't already get this automatic update. Tell us a little bit more about that, Todd, in comparison and where we've used that argument. 

Askew: No, every other Medicare payment system relies on a baseline plus a inflationary based update. It's just true throughout Medicare, whether it be nursing homes or hospitals or home health, or pretty much—I think clinical labs are a little bit different. 

But basically, every other system has this built in. And there's a long history over various attempts at payment reform in the past. Why that is not built into the physician system and why it wasn't built into the last reform was purely a fiscal issue. 

But it's there for everybody else because it makes sense. We can incentivize bonuses and quality with a little change on the margins, a little bit more, a little bit less. But you can't do any of that if the payments are going down. 

And so the baselines with built-in inflationary updates is absolutely critical. And for years and years, for example, the Medicare Payment Advisory Commission, which is a group that advises Congress, said doctors are fine. They're still seeing the patients. Acceptance of Medicare is still very, very high. So we don't need to incentivize them with higher payments. 

And they never recommended higher payments. Now MedPAC has shifted their tune. And over the last couple of years, they have recognized, even though the acceptance is still really high for Medicare patients, it is getting harder to get in. It is taking longer to get appointments. 

And MedPAC has recognized, and they themselves are advising, several different iterations of plans that have a link to inflation because they say this is not sustainable, just as Medicare Trustees have said for the last couple of years. This is not sustainable. Congress needs to act. 

And they're finally getting that message that it doesn't make sense to have a system that just gets eaten away year after year after year by increases in inflation. 

Dr. Scott: Well, the point you just made about the fact that the Medicare Trustees are now hearing the messages is one example of the groundwork that AMA advocacy has laid over the last year. We now have MedPAC agreeing that there needs to be a link to MEI. 

We have the leadership of several of the key conferences on this same point. One of our—a member of our excellent advocacy team was just put in a note to me that says that after the bill is dropped on Friday, there will be information posted immediately in a call to action on our AMA Physicians Grassroots Network. 

Todd, tell us a little bit about the Physician Grassroots Network and the opportunity for people listening to today's call or their colleagues to get involved through that. 

Askew: Absolutely. And I see Kate has put that address out there for everybody to be able to link to it. If you're not a member of the Physicians Grassroots Network, please sign up. This is the way that we can communicate to those physicians who put their names forward and say, I want to be part of the solution. I want to be engaged in this conversation with my member of Congress, with my senators. 

And we can not only push out information to you, but we can do it in a timely way when we know—when our professional advocates like Jason and his team know this is the time to act, this is the time to increase the volume. We can also provide information. 

As things develop, we can keep people informed about new developments with the legislation so that when you have those conversations with your member of Congress, whether it be during the National Advocacy Conference or whether it be back home, whether you see them in the office or see them at church or see them around town, you can have an informed conversation with your member of Congress about this issue. 

So please do sign up and participate. When that alert comes, press this button to email your member, pick up the phone, please do that because that amplifies our voices many, many, many times. And that constituent voice, that physician voice is so much more powerful than all the charts and all the visits we can do as advocates. 

Dr. Scott: And I can address this to either Todd or to Jason. We're getting several questions about people, particularly some pediatricians who've joined us, who are asking, OK, I understand the evidence is on Medicare. What about Medicaid? 

Askew: Sure. I'll be happy to take that. I mean, there are some states, obviously, that actually have improved Medicaid payment rates over the last few years. But that is the perennial problem with Medicaid. 

Underpayment leads to more difficulty in accepting patients. There are networks of physicians, less ability to get care. And then that amplifies the struggles for physicians, especially pediatricians and OB/GYNs, who see a disproportionate number of Medicaid patients in the populations that they care for. 

A lot of the payment rate really comes down to the state level. But we are very engaged. We are very engaged there as well. The bigger thing we have to worry about this year are Medicaid cuts. There are proposals for significant spending on other priorities.

And one of the concerns that we're very aware of is our proposals that we may see emerge to make significant reductions in Medicaid spending. And that's going to just trickle right through to lower payment rates eventually and lower access to care for a lot of Medicaid patients. 

And so we talk about Medicare, Medicare, because here in Washington, that's where we can really have an impact. That's where we see the most significance. But Medicaid is never far from the forefront of our thoughts either, because we recognize those significant issues. And we'll be working to try and prevent or mitigate as much of proposals to make significant cuts there as well. 

Dr. Scott: Well, that's been a pretty good discussion of our number-one issue. Let's go back to Jason for a moment here. And let me ask you, Jason, about other issues that you think that there's a possibility for maybe some of that bipartisan movement that Todd talked about and maybe some other issues that are important to us that we can move on in the 119th Congress. 

Marino: Sure. One I think is best positioned is the Medicare coverage of telehealth. It was shown to be successful during the COVID era. And it was extended to the end of March, the current coverage. That has strong bipartisan support across the board, strong patient support. All the different advocacy groups all support it. 

It's well positioned to get extended further, and maybe not this year, but down the road, it's well positioned to get permanent extension of that coverage for telehealth. And that has been a long journey, but we're well positioned on that one. 

I'd say another top priority, one that kind of stings a bit, is on Medicare Advantage, the prior authorization issue that we were very, very close to getting that passed last Congress in December. And as you know, last administration did some final rules that addressed prior authorization in the Medicare Advantage program. 

And there was an effort and it was based largely on an effort for years now on the Timely Access to Care Act, that a privatization reform bill. And the hope is to codify that reg, that regulation that was finalized, and then add some enhancements, strengthen it a bit. 

And as things kind of, in a chaotic way, unfolded last year, that got left behind. But we hope that there's an effort, a bipartisan effort to bring our champions on that issue back, because we know, unfortunately, that physicians and patients are still going to encounter problems in Medicare Advantage. It's not going away. 

And so it's a matter of reassembling our coalition. And it will take a little bit of time. But we're going to keep working that issue to get it codified and a little more. And so stay tuned on that one. 

I think another one—this is a bill that was introduced earlier this week on Tuesday. It's the Preserving Patient Access to Accountable Care Act. This is a bill that would extend the APM, Alternative Payment Model bonus that expired. It would go to 3.53% bonus for APM participation. 

And there's a criteria threshold for what qualifies to get that bonus payment. And when current law expires, it goes to a level that is—no one will qualify for it. So it freezes the more realistic threshold to qualify for the bonus payment. And that bill was a bipartisan bill introduced earlier this week. 

And that's something that will be part of larger Medicare reform, that piece of it. Because as we all know, where's the APMs? They didn't really come. Some are there, but not what we had hoped. And so the pipeline needs to come together. 

So that is something that we'll work on as part of a Medicare reform effort. Those are three key ones that I think of off top of my head. 

Dr. Scott: I think, Jason, in talking to legislators, all of these issues, what we need to emphasize is access to care. I live in Kentucky. And telehealth has provided opportunity for people because of the flexibility to connect with their doctor without having to travel hundreds of miles to see, particularly, a specialist. So it's about access to care. 

Prior authorization, as a practicing physician, it's incredibly frustrating. But really, the argument is that it harms patients, the delays in the care, the denial of care that our patients need. 

And then finally, simple access to care through the Affordable Care Act expansion. We know, undeniably, that patients who don't have access live sicker and die younger. And those are the arguments that we need to press in Washington, DC, in order to get the federal legislation. 

Now, we've been successful with prior authorization reform. And I think it's 12 states already in the last legislative session. So the AMA is working on a state level as well. 

What are some of the other things that people can do besides coming to the National Advocacy Conference in order to support our legislative agenda? 

Marino: I would say work on your relationships with your members and the staff back home. Sometimes you meet—the district office is fine, or sometimes you can get an email relationship going where you're back and forth and you become a known entity for that member of Congress or their staff back home. 

When I worked in the Senate, there was two physicians that just wooed the Senator I work for. And everything they said was sacrosanct, for better or worse. But I always called them. And they had outsized influence. 

And that's something that you could become. You could become that for some office, some Senator, some staff. That's really important. We're keeping our Fix Medicare Now site updated. So we're always putting new documents on there. 

Mentioned the grassroots team—we're always sending out alerts, timely alerts like please urge remember to co-sponsor this bill, to sign this letter. That's always ongoing. And we appreciate when—and we can track the responses. And the Hill will let us know, the phones are ringing. That always helps. 

And not just restricting your visits to Washington just for a big conference once a year. But find different times—I know physicians are busy—but to the extent that you can find time. It's time well spent investing in this. And then also engaging your colleagues to join, be part of medicine. 

You can't just—be engaged. Just be engaged. Don't just sit back and be overwhelmed by the current situation, but get engaged with medicine and get involved with your specialty group and your state society and get other organizations to care. 

And get your patients—sometimes it's helpful just to let your patients know, I want to be here, and I'm closing because I have to close, and here's why. They don't always know. They don't necessarily know what is happening with Medicare per se and the struggles a physician has. But they don't want the physician to go away. And sometimes involving them in an appropriate way can be very helpful. 

Dr. Scott: Let's go back to Todd. I've got a tough question that has been asked. And I'll turn it over to the boss guy here. Even if we convince people of the arguments, at the end of the day, in Washington, DC, an awful lot of things come down to money. 

What are our suggestions in terms of response to where is the money going to come from, how are we going to pay for it, and is the budget really the hurdle that at least a couple of questioners believe that it is? 

Askew: Yeah. That is a tough question. Yes, there's probably more agreement on the policies than there is on the pay-fors. And that is always a significant burden because significant Medicare payment reform is a very, very expensive proposition. 

There are certainly policies around Washington people have been talking about for years that have different constituencies who would oppose the payment reform because we'd be gutting one of their interests. 

Just this last year, at the end of the year, one part of the bill that fell apart had some fairly significant PBM reforms in it. Those produced savings. There have been proposals to look at various elements of Medicare Advantage reimbursements and increases over the years in Medicare Advantage. Folks have put those policies on the table. 

There's a good deal of interest in increasing transparency and the impact that that can have on health care markets and to potentially produce savings. So those policies are out there. And so it's easier to get consensus around the policy than when you start looking at the pay-fors. You start to create other enemies. 

And that's a challenge. But you build momentum with support on the policy and the urgency of implementing the policy. And pay-fors have a way of finding the policy when the time is right and the urgency of passing the reforms is there. 

The previous reform, when the SGR, the Sustainable Growth Rate payment formula was repealed, that was the pay-for problem. For 10 years, Congress could not decide on a pay-for, so they couldn't advance a policy. 

And then it became so urgent they just did it. In that case, it wasn't entirely paid for. But they got over that pay-for hurdle when the urgency of the problem became so great that it could no longer be ignored. 

Now I think we're there. I think we're past there in terms of having a problem that's so urgent that Congress should be able to focus and find a way to get over that hurdle. So we just need to continue to tell those stories and push and help them see that. 

Dr. Scott: So just a couple of specific questions for either of you. People want to know if there's a name or a number on the APM legislation, if there's a sponsor, so people can refer to that in their advocacy with their legislators. Let's do that one. That's a straightforward one. Either one of you on that. 

Marino: I'll jump on that one. So that APM bill that was introduced on Tuesday is the Preserving Patient Access to Accountable Care Act, H.R. 786. And it was introduced by Congressman LaHood and Congresswoman Dr. Schrier. 

And I'm sure they would appreciate the support, any letter of support. And if you go on congress.gov and you pull in H.R. 786, you can see who—there may have been some new co-sponsors added as well. It'll be constantly updated. 

Dr. Scott: So I have another question that I'm seeing here. And maybe this will be a segue over to a little discussion of some longer-term strategy that we'll get to in just a minute here. But people want to know where are we on extending the ACA subsidies versus cuts in the ACA subsidies, which I know you've touched on a little bit earlier. But there's a couple more questions on that. 

Askew: So we are engaged. We're part of a large coalition effort called Keep Americans Covered to bring pressure to extend the premium—the tax subsidies. That's premium tax credits that make premiums accessible to—or make coverage accessible to people at slightly higher incomes that otherwise would not have access. 

Those credits expire at the end of this year. But really, the deadline is really this summer because the plans have to decide what markets they're going to be in and how they're going to price their products based on the knowledge of how many consumers will have access to credits and to be able to afford care. 

You're likely to see if they expire, not only will some people lose access to premium subsidies altogether, but even those who continue to have access will see some significant premium increases. 

And that Keep Americans Covered website has a calculator where you can go in district by district, state by state, zip code by zip code, and put in information to see how premiums could be impacted if those credits expire. 

Doing it permanently is very expensive. Our pledge, our push right now is just don't let them expire. Do it one year. Do it five years. Do it permanently. Whatever we can muster in this moment, the most important thing is not letting them expire. 

And that effort is going out not only here in DC, but it is out in the field. It is working in targeted districts around the country to build community support and to work with the legislators back home to show them the impact, the expiration of those credits.

The pathway is pretty murky right now. The obvious vehicle would be reconciliation. But that's a big spin. And it takes away from other things that may be prioritized for what's going to go in the reconciliation package. 

And so that's another effort though, where continuous pressure and continuous education of members of Congress about what the impact of the expiration of these premium tax credits, what that would mean for their constituents. But it is something we're very, very engaged in. 

Dr. Scott: So, Todd, let's stay with you. Let's shift a little bit. I know you talked about this a little bit at the beginning of our telecast today. But maybe we had new people joining us. People are interested—we have a midterm election coming up in two years. We have another presidential election coming up in four years. 

It almost feels like we just got through a presidential election. But I guess it's time to start thinking long-term. Talk to us a little bit about AMA's strategy and long-term overlook as we look beyond these first few days and weeks of the new administration and new Congress. 

Askew: I think a lot of these priority issues we talk about, whether it be prior authorization, administrative burden reduction, fiscal stability in terms of adequate payments, a lot of these are about physician wellness and helping physicians find that joy in practicing medicine again. 

Because I know, Dr. Scott, that physicians you hear from, the ones I talk to every day, many of them are just absolutely miserable right now. The pressures of practice, the financial pressures, the paperwork, the battling insurance companies, the actual loss of trust, quite frankly, in physicians. 

You've seen in society, you've seen those that have been really held in high esteem over the last four or five years, not just physicians, but across the board, the public is becoming less trustful of people. And it's really taken a lot of that joy away from practicing medicine. 

So many of these things we're working at aim to restore that, aim to lighten the financial burden, to reduce the administrative burden, to give physicians more time with patients, which is a constant uphill battle. It's not just in the advocacy space. I think you could look at any unit across the AMA and find them doing work that is essentially about helping physicians have more joy. 

We have our Joy in Medicine™ Recognition Program. It's one element of that. But helping physicians remember why they became physicians and be able to practice in a way they want to practice, serve their patients in a way that they think is best and that can produce the highest quality care. 

So we fight these battles one thing at a time—Medicare reimbursement rates, Medicaid cuts, prior authorization reform. But I think the long-term picture is just that. It's reducing obstacles that get in the way of being able to serve patients and find that joy in medicine again. 

Dr. Scott: We know that physician burnout reached an epidemic proportion of above 60% during the pandemic. It's come down. It's now 48%. But I don't think anybody can delight or rest on our laurels of an almost 50% of our colleagues are burned out. 

And so we need to continue our efforts to try to not only treat the root causes of the burnout, as we're talking about here today, but also reduce some of the stigma surrounding mental health care in general, but particularly for physicians. 

Askew: And that is something we have worked very hard on. Our team has worked with state licensing boards, with health care systems, with groups around the country to destigmatize, particularly histories of mental health episodes, for example. 

Why is that on the licensing thing if it's not a current ongoing problem? Because it does stigmatize physicians, and it makes people less willing to get the help that's available to them. So anything we can do to lighten that burden and to help physicians focus on their own wellness, because like you said, if they're burned out, they're not going to be best able to care for their own patients. 

Dr. Scott: Well, we have a moment while I'm looking for some more questions to come in. Tell us a little bit more about the National Advocacy Conference, the speakers you have lined up and the opportunities for people to get involved by attending that conference. 

Askew: Jason, do you want to take that? 

Marino: Sure. So we have a special event in the Cannon Caucus Room. I think it's where the McCarthy Hearings were. This is a historic room. There's a part that we were told you can't touch that area. It's historic. 

But it's big. 450 people can fit in the room. And we're going to have, at that event, in that room, we're going to have Dr. Congressman Murphy, Congressman Panetta, Dr. Ruiz, Dr. Schrier, Dr. Joyce. 

We're going to have seven total. And they're going to basically speak back to back to back, 10-minute increments, or 5 to 10 minutes. And mostly going to talk about the importance of getting the Medicare Patient Access and Practice Stabilization Act that I mentioned, the one that's introduced on Friday, why that's so important. 

And there'll probably be a message of stay engaged. We're fighting for you, but stay engaged. Keep telling your story. Don't let up. That'll be kind of be the mood of that. 

And then we'll have the traditional National Advocacy Conference that takes place in the Grand Hyatt sub-sub-basement. We have that big room there. 

And we're inviting a lot of the new physician members, as well as Dr. McCormick, and a lot of the newer members with the idea that it's important when you're a physician member and you're just elected, and then you could come to the AMA and be around physicians—when we've done that with Dr. Ro and Dr. Murphy earlier in their careers, it's been very helpful. 

And they'll be partners. And it's important to embrace—when we have our colleagues that make it to Congress, it's great to have allies. A lot of lawyers in Congress, so it's great to have physicians. 

And so we're going to have them speak. And then we're going to have a group called the Mehlman. It's one of our consulting groups that's going to come and do big picture—kind of lay out the landscape of what's happening in current events in the Congress and administration. 

And then everyone, in the afternoons, is going to go to meet with their senators and their House offices. And we're going to have—we're very focused on this one on Medicare. We're going to have one handout. It talks about this bill that I just mentioned, about stopping these cuts and getting an update for 2025. 

And then the other handout is going to talk about the importance of getting permanent Medicare payment reform, permanent MEI, fixing the payment system overall. So they'll have those to go to the Hill with. 

Askew: And I would also add, we mentioned MedPAC earlier. We believe we're having the executive director of MedPAC to come and talk about their thinking and how they've evolved a bit on Medicare physician payments and what their ideas are and their proposals for reform going forward. 

And also, if you're a political junkie and you watch a lot of news like we do, Jake Sherman and Anna Palmer from Punchbowl News—Jake is one probably one of the best, in my opinion, Capitol Hill reporters and really having his thumb on the pulse of what's going on on Capitol Hill. 

And so I think it's going to be fascinating to hear his take on how this new Congress is rolling out. I was just watching him this morning. He's down in Miami with the Republican leadership right now. 

Dr. Scott: Todd, I think you were the one who brought this up. Someone has a specific question about what was the source of the impact of the ACA tax credits by state that you mentioned earlier. 

Askew: I'm going to—

Dr. Scott: Jason—

Askew: I'm going to have Kate—we'll look—I can't put my finger on the website right now. 

Dr. Scott: We can have Kate—

Askew: I will have Kate put it in the chat. But if you will go to—I think, Keep Americans Covered is the group. And they have that resource on their website. 

Dr. Scott: OK. And I've heard this next question out on the trail. People say, OK, we understand how the Medicare and Medicaid cuts impact private-practice doctors. But how does this impact employed physicians or physicians in other modes of practice? 

Marino: The Medicare physician payment system underlies all payment systems—even if you're a physician practice that got bought out by a hospital system, for instance, you're still part of the payment system. It's still going to impact you at the hospital. 

And it could be a situation where, geez, the payments that the hospital can tell the physician that employed now, well, we're getting less payments for Medicare now, and we're going to need you to do a little more here. We're not going to be—we're going to have to freeze your—your standing might be jeopardized because there's cuts.

It's going to—and hospitals do care about these cuts. They feel them. They just know that, well, they have other issues that they're working on. And they know that we've got—the AMA's going to lobby hard on the physician payment cuts. But it does hit downstream. 

It also hits physical therapists. There's a waiting list for many physical therapists right now because they get paid through Medicare and other providers that are linked to it. So it is downstream impact. It's not just private practice. 

Dr. Scott: So people are asking about scope of practice. We mentioned that at the beginning. And I know that a lot of that is on the state level. But do we want to talk a little bit about what AMA is doing on a federal level and some of the activities there, and maybe also introduce some of our state activities as well? 

Marino: I can start first. I'll just say that it is a scary—it's a real threat that we face in Congress on the scope of practice. Last Congress, there was a lot of momentum, a lot of bipartisan momentum to expand the scope for pharmacists. Let them do more. Let them do some diagnosing, some testing, some treating. 

And they were getting a lot of traction. And their argument was, look, there's a physician shortage, which is true. There is a physician shortage, specialist, primary care. And hey, we're here at a local community pharmacy. There might not be a physician for 100-miles radius. 

And I can do more. I want to do more to help address this shortage. And I can do more with my patients. Just let me do more. And that's compelling to a lot of members. And so we come in and give the counter side of it. 

Well, first of all, there's a lot of training that's involved when you treat and diagnose a patient that you can't just disregard. And we are doing things like increased advocacy for GME funding, for my residency spots, things that address the physician shortage. 

And by the way, this broken Medicare payment system is not helping. It's not good when practices close up because they're being starved by Medicare. And we're trying to address that. 

But also a lot of these larger, big box pharmacy retailers that are also corporate-owned and the pharmacies are employed. And this is kind of a way of them getting more market share and able to bill more. That's not necessarily the best interest of the pharmacist, but that's out there. 

And we're going to—and we were successfully made sure that didn't pass last Congress. But it's coming right back. There's chiropractic space. There's a nurse practitioners, nurse anesthetist. It's a constant—and the driving theme is that there's a shortage of physicians. And hey, we're here to help. 

And our response is they're very valuable members of the team. We want them on the team. Thank god they're there. But physician with the training should lead the team. And we are trying to address the shortage. And there's things Congress can do to address the shortage. 

But that is something that we have to be very—and we're going to remain very vigilant on. And it's tough. It gets emotional. It gets very charged. But we're going to be facing that. And Todd, I know that that's an issue at the state level that has been a perennial one. 

Askew: No. And just absolutely I think that the opportunities at the state remain considerable. Or not opportunities maybe, the threats at the state. And we are very successful in partnership with the specialties and especially with the state medical associations in knocking down a lot of the challenges we find in the states every year. 

But a couple are always going to get through. So I think it's important that we still continue to talk about team-based care, physician-led, team-based care, where everybody is able to contribute and participate to the extent of their training, but ultimately, making sure that a physician is involved in some way in patient care always. 

Dr. Scott: Well, while we have you, Todd, I know there's a lot of concern. I'm hearing a lot, getting a lot of emails and hearing a lot of concerns about many of the executive orders that have come down, some of the nominees, and basically, a lot of the things that have been happening in this first week or so. 

And will you give us an overview of AMA's thought on this, and strategy for going forward and how this impacts our overall agenda, and really, the strategy for going forward. 

Askew: Sure. So there has been a slew, a flood of executive orders and other actions by the new administration that I know we hear a lot of concerns about many of those actions from a lot of our members. 

And look, this is what—a lot of these things are what they promised they would do, that this is what they ran on, and they won. And they are acting on the promises that they made and that these were important enough to the agenda that they did them the first day or the first week. 

I mean, it seems like it's been going on a while. We're, I think, in day nine of the new administration. And when you have this pace of stuff coming out, a lot of it is noise. A lot of these things are policy statements that don't do much but set a direction. 

Now, there are some—I don't want to downplay it. There are some that have some immediate, immediate impact, but a lot of them are at 60 days for a report, 120 days to come up with a plan. And a lot of these, they're not like self-executing. 

We will have an opportunity to engage with the administration on these issues, on our concerns, on talking about some of the policies or the implications some of these changes may have for patient care and for physician practices. And we are obviously committed to do that. 

But the best way to do that, as I talked about at the top of our conversation here, is not necessarily a battle of press releases or just a show of indignation. It's engagement in a strategic way where we can talk through some of these policies with those that are charged in implementing them, and see what kind of impact we can have there. 

And so we are committed. And we are 100% committed to pursuing AMA policies in all of these areas. But it's not something that we're going to be able to react in real time to everything, because we have to be a little bit more strategic than that. 

And I know that's not very satisfying for a lot of people. It's not very satisfying for people who are engaged in advocacy full time. But it's, I think, the right thing to do and to be more deliberate and purposeful in how we work on these and staying focused so that we can preserve our role as the voice of the physician community and use that voice to implement and to pursue our policies. 

Dr. Scott: Well, thank you for that, Todd. And unfortunately, I think that's about all the time we have for today's webinar. Obviously, there's much more to talk about regarding the AMA's advocacy agenda. 

Thank you, Todd. Thank you, Jason, for your insights into the national advocacy landscape for 2025. And I want to thank all of those who put questions into the chat and for asking questions. 

Be sure to join me and the AMA in a couple of weeks in Washington, DC, for the AMA National Advocacy Conference, where we'll be urging Congress to fix Medicare now, along with dealing with our other legislative priorities, an opportunity to hear from congressional leadership and from other leaders who are going to implement some of our policy. 

Until then, visit the AMA website. That's ama-asn.org to register and to get more information about the AMA advocacy priorities, both at a state and a national level, which are meant to reflect the needs of physicians and our patients. 

As we move into this new year, the new players, the new administration, the new senators and congresspeople, we want to enter into discussions and educate those individuals and take advantage of the opportunity to hopefully be able to educate them about health care. 

I truly believe that when we, as physicians, speak with a unified voice, we have the power to fix health care for our patients and for ourselves. We need to unite around these items. And we need to use that voice. 

If you'd like to watch previous AMA Advocacy Insight webinars, you can find them on our website. That's ama-assn.org. Hope all of you can join us for our next webinar in this series, which will be announced at a later date. Until then, stay well. Thank you and good day. 

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.