January 31, 2025
ACEP in Washington DC
Action On Capitol Hill
ACEP-supported Rural Emergency Care Access Bills Introduced
On Tuesday, Representative Mark Green, MD (R-TN) introduced two ACEP-supported bills focused on improving access to rural emergency care by eliminating outdated regulatory barriers. Rep. Green, an emergency physician, member of the House GOP Doctors Caucus, and member of the Congressional Bipartisan Rural Health Caucus, reintroduced the “Rural ER Access Act” (H.R. 772) and the “Rural Health Care Access Act of 2025” (H.R. 771).
The Rural ER Access Act would eliminate the current requirement under the Medicare program that an off-campus freestanding emergency department or off-campus facility be located within a 35-mile radius of a hospital or critical access hospital (CAH). Similarly, the Rural Health Care Access Act would expand the definition of CAHs by repealing an existing rule that prohibits rural hospitals from pursuing a CAH designation if they are less than 35 miles from an existing hospital.
ACEP President Alison Haddock, MD, FACEP, was quoted in Rep. Green’s press release on the bills, stating, “Rural emergency departments (EDs) are the health care safety net for some of our country’s most vulnerable and underserved communities, providing 24/7/365 access to lifesaving care for 60 million people in the U.S. These EDs operate under growing strain as they face critical shortages of qualified medical staff with limited resources and the ever-present threat of closures. ACEP is grateful for Representative Green’s leadership, as a legislator and an emergency medicine colleague, in introducing the Rural Health Care Access Act and the Rural ER Access Act. These bills will help stabilize and preserve access to rural emergency care, ensuring that our patients can get the care they need and deserve, no matter where they reside.”
Dr. Lorna Breen Health Care Provider Protection Reauthorization Act Introduced in Senate
Also on Tuesday, Senators Tim Kaine (D-VA), Todd Young (R-IN), Jack Reed (D-RI), and Roger Marshall, MD (R-KS) reintroduced the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, an ACEP priority bill that would reauthorize funding for the law named in honor of the life and legacy of Dr. Lorna Breen, an emergency physician who died by suicide during the pandemic. ACEP was instrumental in the drafting and 2022 passage of this law, which has since provided $100 million for mental health resources, education and support for physicians and health care workers.
The bill reauthorizes the law for five years, providing grants for health care organizations, associations, schools and others to prioritize strategies to reduce burnout and resources for peer-support programs, suicide prevention training, and mental and behavioral health treatment. The bill also includes reauthorization for a national evidence-based education campaign. The full text of the bill is available here.
ACEP President Alison Haddock, MD, FACEP, in thanking our congressional leaders on this critical ACEP priority, said, “With strong ACEP support, the Dr. Lorna Breen Health Care Provider Protection Act became the first federal law focused on addressing the barriers preventing physicians and health care workers from receiving mental health care. Emergency physicians face the highest rates of stress and burnout in medicine and there’s no question, this law is saving lives and protecting livelihoods. We fully endorse the reauthorization of this vital law honoring the life and legacy of our emergency medicine colleague and strongly encourage its prompt passage.”
Bipartisan Medicare PFS Fix Bill Introduced
On Friday, a broad bipartisan coalition of House members introduced the “Medicare Patient Access and Practice Stabilization Act,” legislation to reverse the 2.83 percent Medicare Physician Fee Schedule (PFS) cut that went into effect on January 1, 2025, and also provide a 2 percent update for 2025 to help account for inflationary pressures on physician payment. The bill is led by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Marianette Miller-Meeks, MD (R-IA), Kim Schrier, MD (D-WA), John Joyce, MD (R-PA), Raul Ruiz, MD (D-CA), Carol Miller (R-WV), Ami Bera, MD (D-CA), Claudia Tenney (R-NY), and Raja Krishnamoorthi (D-IL).
At the end of 2024, Congress passed a continuing resolution that did not include the proposed 2.5% relief for the 2.83% Medicare Physician Fee Schedule cut, which took effect on January 1, 2025. Without congressional intervention, these cuts have further strained emergency departments and physicians, jeopardizing patient access to timely and essential care. This legislation seeks to alleviate the financial burden on emergency physicians in the short term, ensuring that Medicare payments keep pace with rising costs and that health care providers can continue delivering high-quality care. With ongoing concerns over Medicare reimbursement instability, ACEP also continues working with members of Congress to develop long-term solutions to implement a sustainable payment model that safeguards both physicians and patients.
ACEP will continue to monitor the progress of this bill and advocate for legislative solutions that support emergency medicine.
RFK Jr. Faces Senate Committees for HHS Nomination
On Wednesday and Thursday, Robert F. Kennedy, Jr., appeared before the Senate Finance Committee and Senate Committee on Health, Education, Labor, and Pensions (HELP), respectively, as the Senate began consideration of his nomination for Secretary of the U.S. Department of Health and Human Services (HHS). While both committees held hearings on the nomination, only the Senate Finance Committee votes on advancing HHS nominees, while the HELP Committee hearing is a courtesy hearing.
Both hearings were contentious as expected and at times emotional, with Kennedy grilled by Democratic members of the committees, while many of the Republican committee members asked him to expound on his approach to chronic disease and his “Make America Healthy Again” plans around improving nutrition, health, and well-being for Americans. While Republicans were generally more receptive and open to Kennedy’s stated plans, several, including HELP Committee Chairman Bill Cassidy, MD (R-LA), questioned him about his previously stated views on vaccines and vaccine safety and offered him several chances to clarify his positions.
During both hearings, RFK stumbled on several occasions, at times confusing Medicaid and Medicare policies, as well as appearing to be unfamiliar with the specifics of the different parts of the Medicare program. Kennedy also faced questions on the Emergency Medical Treatment and Labor Act (EMTALA) during both hearings. On Wednesday, Sen. Catherine Cortez Masto (D-NV) questioned him about whether EMTALA protects a woman’s access to lifesaving emergency care in a state where abortion is banned if an emergency abortion is required, to which RFK responded that he did not know. On Thursday, Senator Lisa Blunt Rochester (D-DE) also challenged Kennedy on his understanding of EMTALA and emergency care for pregnancy complications. She asked whether he believed that “a person presenting to an emergency room with a severe illness should have any type of emergency care needed to save their life.” When Kennedy responded affirmatively, she followed up, asking if the same standard applied to a person experiencing severe pregnancy complications, including access to emergency abortion care if medically necessary. Expressing concern over his lack of clarity, she stated, “Women should not be forced to rely on emergency airlifts to other states for life-saving care.”
As of now, it remains unclear if Kennedy will be confirmed, with all eyes on Sen. Cassidy (though Chairman of the HELP Committee, Cassidy also sits on the Finance Committee and is expected to be the deciding vote). Despite Sen. Cassidy offering Kennedy multiple chances on both days to clearly state that he will support established science and vaccines, RFK did not answer directly, leaving Cassidy to express some uncertainty about where his vote stands at the end of Thursday’s hearing.
Regulatory and Administration News
Navigating Immigration Enforcement in the Emergency Department
On January 20, a previously existing policy that had directed officers of the U.S. Immigration and Customs Enforcement, or ICE, to generally avoid conducting enforcement activities at protected areas including hospitals, churches, and schools, was rescinded by the Department of Homeland Security. Therefore, ICE officers are no longer discouraged from conducting enforcement activities in such areas, and the change could potentially lead to increased enforcement activities in hospitals.
Despite this change, a hospital's response to the presence of ICE officers should generally not be different from what it was previously. ACEP has developed a new resource to provide you with a deeper explanation of what this means for emergency departments, and guidance on what to do should ICE officers present themselves in your ED.
Announced Pause of Federal Financial Assistance and Grants Causes Confusion
On Tuesday, the Trump administration issued a memorandum through the Office of Management and Budget (OMB) directing federal agencies to temporarily pause all activities related to the obligation or disbursement of federal financial assistance, in order to allow for a “comprehensive analysis” to ensure its grant and loan programs are consistent with the President’s recent executive orders. The announcement led to widespread confusion and concern, as it potentially would affect a vast array of programs, including Medicaid, Head Start, Meals on Wheels, and various educational and disaster relief initiatives. Despite the memo’s specific exclusion of Social Security and Medicare and assurances that direct assistance programs would remain unaffected, many states reported disruptions to accessing their Medicaid portals.
Legal challenges quickly emerged, and opponents of the pause argued that the administration's action violated the Impoundment Control Act of 1974, which restricts the executive branch from unilaterally withholding funds appropriated by Congress. A federal judge temporarily blocked the funding freeze until Monday, Feb 3, leading the OMB to rescind the memo the following day. The Administration then stated that the rescission was only of the memo itself and not the pause of federal financial assistance, leading another federal judge to signal he would again block the freeze.
Significant confusion continues and the situation remains fluid. ACEP continues to closely monitor the situation and is assessing the potential impacts on emergency physicians and their patients.
