ACP is calling on all Advocate for Internal Medicine network (AIMn) members to engage with us in a "Write to Congress" campaign to urge lawmakers to act on important legislation this year that will help ensure continued access to care for our patients. The nation is facing a critical shortage of physicians, and those in private primary care practices are being compensated at lower rates in most state-run Medicaid programs than Medicare for the same services rendered to Medicaid patients. In addition, physician Medicare payment has failed to keep up with inflation. Furthering complicating timely access, many patients who are treated by physicians in group health insurance plans are required to fail first on the plans’ prescriptions before the prescribed drug can be dispensed.  To address these critical issues, we need your help in urging Congress to act by: 

• Passing H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments.
• Passing H.R. 952, the Kids’ Access to Primary Care Act, which aligns Medicaid reimbursement rates with Medicare payments.
• Passing H.R.2630/S. 652, the Safe Step Act, which requires group health plans to provide an exception process for any medication step therapy protocol to help ensure that patients can safely and efficiently access treatment.
• Passing H.R. 1202/S. 704, the Resident Education Deferred Interest Act, (REDI), which allows borrowers in medical or dental internships or residency programs to defer student loan payments until the completion of their programs.
• Passing H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported graduate medical education (GME) positions by 14,000 over seven years.  

Background: ACP encourages efforts by federal and state governments to support patient access to physician care by enacting policies that facilitate adequate payment for medical services, help grow the physician workforce, reduce administrative burdens on physicians and remove barriers to patients obtaining the treatments they need.

We urge Congress to act this year to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which would preserve access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the Medical Economic Index (MEI). As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Unless Congress acts, a statutory freeze in annual Medicare payments for physicians is in place until 2026, when payment updates will resume at a rate of 0.25 percent a year, well below inflation rates. ACP is asking Congress to adjust Medicare physician payment rates for 2024 based on the MEI.   

Additionally, to promote greater patient access and health equity, ACP urges Congress to pass H.R. 952, the Kids Access to Primary Care Act, which ensures that Medicaid payment rates for primary care services are equal to Medicare rates. The ACA included a provision that required states to raise Medicaid payment rates for primary care services equal to Medicare rates in 2013 and 2014 but this provision expired after those two years and was not renewed by Congress. Under Medicaid, on average, a clinician treating a Medicaid enrollee is paid about two-thirds of what Medicare pays for the same services and only half of what is paid by private insurance plans.

We are also urging Congress to pass the Resident Education Deferred Interest Act (H.R. 1202/S. 704). This legislation makes it possible for medical residents to defer interest on their loans.  While the REDI Act does not provide loan forgiveness or reduce a borrower’s original loan balance, it prevents physicians and dentists from being penalized during residency by precluding the government from charging interest on their loans during a time when payments on student loans can still be deferred. With an aging population experiencing higher incidences of chronic diseases, it is especially important that patients have access to physicians trained in comprehensive primary and team-based care for adults—a hallmark of internal medicine GME training. We therefore urge Congress to pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, to increase the number of DGME and IME positions by 14,000 slots over seven years. 

Finally, Congress should pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Among these, step therapy policies, commonly called “fail first” policies, require patients to be initiated on lower-priced medications before being approved for originally prescribed medications. Carriers can also change coverage in an attempt to force patients off their current therapies for cost reasons, a practice known as nonmedical drug switching. 

Action Requested: Please send a letter to your members of Congress expressing the need to act on these important priorities. A sample letter has been provided for you that includes blank fields where you can personalize the letter. 

Please contact Shuan Tomlinson at stomlinson@acponline.org with any questions about this campaign. Thank you for your continued advocacy.