In the News

Physicians are already working under a Medicare pay cut that kicked in Jan. 1, and there doesn’t seem to be a clear path yet to fixing the issue in Congress.

Doctors' groups and lawmakers are concerned the Medicare-compensation problems will exacerbate issues for an already stressed workforce and impact beneficiaries’ access to services. Some of those issues include hiring freezes, physicians limiting the number of Medicare patients they serve, and potential harm to small, rural practices.

Navigating Medicare pay cuts is a Groundhog Day issue for physicians, as groups including the American Medical Association annually lobby Congress to avert a decrease in doctors’ pay under the program. Some lawmakers have put forth longer-term reforms to help fix the Medicare-pay problems on a more permanent basis.

The task of fixing payment issues may be about to get harder. But after this year, key champions of Medicare payment fixes and reforms will be departing the House: Republican Reps. Michael Burgess of Texas, Larry Bucshon of Indiana, and Brad Wenstrup of Ohio—all doctors. Wenstrup and Burgess are both cochairs of the GOP Doctors Caucus, and Bucshon is a member.

While some industry experts are confident other lawmakers will take up the mantle, others worry about the immediate loss of experience and knowledge.

“I’m heartbroken. I’m absolutely heartbroken,” said Republican Sen. Roger Marshall of Kansas, who is an OB-GYN. “Those three people have an encyclopedia of knowledge of past policy: what worked, what didn’t work, what we did that we wished we had done differently.”

He said that the chances of a long-term fix “are pretty well out the window.”

Democratic Rep. Kim Schrier, a pediatrician, told National Journal that she is concerned “whenever a level-headed, knowledgeable member of Congress in either party leaves.” She said that Burgess and Bucshon have been “great partners to work with."

"We speak a common language: We’re all physicians.”

Jesse Ehrenfeld, the president of the AMA, said it was going to be hard to replace the congressmen. “With Medicare access being so threatened today, we need the voice of physicians more than ever,” he said. “They know what it takes to provide health care and the challenges in running small practices.”

Burgess in 2015 spearheaded the effort to address physician-payment problems by repealing the sustainable growth rate, which was the way the Centers for Medicare and Medicaid Services would update the physician-fee schedule at the time. Physician pay was reduced under that system if expenditures exceeded a certain threshold each year. Congress stepped in to avert decreases in pay from the early 2000s to 2015. But without further intervention, actuaries estimated that physicians in 2015 would have faced a 21 percent pay cut.

The Medicare Access and CHIP Reauthorization Act of 2015, sponsored by Burgess, repealed the sustainable growth rate, created a merit-based incentive payment system, and established incentives to get physicians to participate in alternative payment models. The measure passed Congress with bipartisan support, including from Wenstrup and Bucshon.

But payment issues persist. Physicians' groups every year continue to sound the alarm over decreases in pay, and lawmakers have provided spot fixes to stop some of the cuts in recent years.

The Centers for Medicare and Medicaid Services last year finalized a decrease to the conversion factor, which helps calculate Medicare physician pay, by 3.4 percent. The decrease kicked in at the beginning of 2024, despite calls from doctors in Congress to take action to offset the cut.

The decrease is due to budget-neutrality requirements and statutory adjustments, according to the AMA.

“As an internal medicine doctor by training, I am keenly aware that these payment cuts will further strain our health care system, hinder the ability for health care professionals to provide quality care to their patients, and slow the transition to value-based care,” Democratic Rep. Ami Bera of California said in a statement to National Journal. He also said he was saddened by the departure of his Republican doctor colleagues.

Bera joined Schrier and Bucshon, along with another GOP doctor, Rep. Mariannette Miller-Meeks of Iowa, in leading nearly 200 members of Congress in a December letter to leaders warning that the Medicare cut would lead to hiring freezes, delay system improvements, and hinder the transition to value-based care systems.

Bucshon said there is a “pretty good” chance that the cut will be addressed, but that he wasn’t sure if the entire decrease would be covered. He noted that both the Senate Finance Committee and the House Energy and Commerce Committee advanced proposals that would shift a statutory pay increase from 1.25 percent to 2.5 percent. This offsets the 3.4 percent cut by only 1.25 percent.

A measure introduced by GOP Rep. Greg Murphy of North Carolina, and supported by Bucshon, Burgess, and Wenstrup, would fully address the cuts by pulling from the Medicaid Improvement Fund. The legislation is supported by the AMA.

While it has drawn support from 11 House Democrats and 41 Republicans, Schrier said she couldn’t support it due to its reliance on funds from Medicaid. “I’m a pediatrician, so pulling from a program that is so critically important for children and families, and pregnancy and childbirth, was not a trade-off that I wanted to make,” she said.

Schrier worked with Bucshon, Burgess, and Wenstrup on the Energy and Commerce measure that also adjusts the budget-neutrality threshold so that physicians aren’t facing frequent decreases in pay.

Burgess called the markup of this bill historic, saying in a statement to National Journal that this was the “first-ever consideration of a budget neutrality bill and a doc fix during my tenure.”

The Texas doctor added that he plans to focus on other potential changes to Medicare’s payment structure, including ways to improve quality measurement, ease the burden of the merit-based incentive payment system, and assess the efficacy of alternative payment model incentives.

Bucshon hopes to make more substantive changes to the system before he departs Congress. He cosponsored legislation with Rep. Raul Ruiz to tie physician payments to medical inflation. The legislation has widespread bipartisan support. But Bucshon conceded the solution is costly.

“I think the issue is really important enough that I think we might be able to make some headway,” he said.

Bucshon said he’s not concerned about support for these issues when he departs. “We’ve really developed a lot of support on these issues for nonmedical people in Congress on both sides of the aisle,” he said.

Wenstrup told National Journal in a statement that he was confident “the members of the GOP Doctors Caucus will continue to recruit physicians, using their real-world health care experience to craft legislation that puts America’s patients first in the years to come and we continue to champion from the outside as well.”

Industry groups told National Journal that they are working to bring in a new generation of doctors to work on these issues.

Ehrenfeld said the AMA is always looking for new champions in Congress and runs a candidate school to help physicians enter the political arena.

Aisha Terry, the president of the American College of Emergency Physicians, said there is a “pipeline” for health care workers and physicians to serve in Congress. She said the group has fellowships “with the hope that one day those shoes—which are huge, no doubt about it—will be filled by future pipeline leaders.”

Anders Gilberg, the senior vice president of government affairs at the Medical Group Management Association, said that “institutional advocacy within the House is absolutely critical to having long-term reform, not just patching up these cuts.”

“Our hope is that there will be a new class of members of Congress that will step in and fill these roles,” Gilberg added. “But for those of us that remember the [sustainable growth rate], it’s always very helpful to have members of Congress that also remember that and what a mess it became with the short-term fixes.”