This week, Representatives Debbie Dingell (D-MI), Brian Fitzpatrick (R-PA) and 42 of their colleagues sent a bipartisan letter to Health and Human Services (HHS) Secretary Xavier Becerra, urging him to establish a task force of appropriate stakeholders to address the emergency department (ED) boarding crisis occurring nationwide.

The letter – one of ACEP’s priorities during last month’s Leadership and Advocacy Conference (LAC) – lays out the ongoing challenges facing patients, emergency physicians, and nurses in EDs, and highlights many of the boarding stories shared by ACEP members. The Dingell/Fitzpatrick letter follows ACEP’s and more than 30 other organizations' similar call for the White House to convene a summit of health care leaders to spur collective action needed to resolve this crisis. The strong bipartisan support of the letter is a testament to your successful advocacy through LAC meetings, ACEP’s 911 Grassroots Network, and ACEP’s new Advocacy Leaders program.

ACEP deeply appreciates the leadership of Reps. Dingell, Fitzpatrick, and the more than 40 other bipartisan members in bringing this public health emergency to the forefront, and for continuing to urge the Administration to take needed action to convene relevant stakeholders who can identify and help develop the policy solutions necessary to improve patient care and working conditions for emergency physicians and other staff who provide the health care safety net.

In addition to Reps. Dingell and Fitzpatrick, the letter is signed by Reps. Lisa Blunt Rochester, Shri Thanedar, Stephen Lynch, Alma Adams, Lance Gooden, Seth Magaziner, Eleanor Holmes Norton, Annie Kuster, Paul Tonko, Tony Cárdenas, Mariannette Miller-Meeks, Chellie Pingree, Dan Goldman, Don Davis, Marie Gluesenkamp Perez, Raúl Grijalva, Nanette Barragán, John Joyce, Andy Barr, Terri Sewell, Marc Veasey, Jasmine Crockett, Angie Craig, Emanuel Cleaver, II, Kim Schrier, Bill Foster, Larry Bucshon, Ami Bera, Derek Kilmer, Brittany Pettersen, Mike Thompson, Becca Balint, Bill Johnson, Haley Stevens, Adam Schiff, John Sarbanes, Sean Casten, Robin Kelly, Mark DeSaulnier, Neal Dunn, Lizzie Fletcher, and Raul Ruiz.

This week, the House and Senate passed an agreement to lift the debt ceiling until early 2025, averting an imminent default on the national debt and potential global financial crisis, and giving legislators significant breathing room by clearing a political obstacle that has consumed both chambers of Congress all year.

After weeks of negotiations, Speaker of the House Kevin McCarthy (R-CA) and President Joe Biden were able to cobble together a deal that received substantial (and somewhat begrudging) bipartisan support. The bill raises the debt ceiling until January 2025, establishes new spending caps aimed at cutting the deficit, rescinds unspent COVID-19 funds, establishes new work requirements for federal food assistance programs, and includes provisions related to the federal energy permitting process as well as a provision ending the COVID-19 public health emergency pause on federal student loan repayment.

The Treasury Department had warned legislators in late May that it would run out of money to repay its obligations on June 5, giving Congress and the Administration a tight deadline to get a deal across the finish line. The House of Representatives passed the measure in a 314-117 vote on Wednesday evening, and the Senate was able to accelerate its typical process and pass the bill in a 63-36 vote late last night. With one major crisis at least temporarily averted, Congress will now refocus its sights on the annual appropriations process under the new constraints set by this deal, as well as other priorities ACEP is monitoring, such as the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA) and others.

For decades, Medicare physician reimbursements have failed to keep up with inflation, despite other Medicare participants receiving annual inflationary updates. During ACEP’s Leadership & Advocacy Conference last month, attendees described how the yearly threat – and implementation – of significant cuts to Medicare physician payments continues to destabilize our nation’s health care safety net. Legislators were asked to provide much-needed stability to the Medicare system by co-sponsoring and supporting the bipartisan “Strengthening Medicare for Patients and Providers Act” (H.R. 2474), which will establish an inflationary update in the Medicare Physician Fee Schedule (PFS) based on the Medicare Economic Index (MEI).

Contact your Representative today to support the “Strengthening Medicare for Patients and Providers Act”. 

California ACEP is pushing for an increase of the reimbursement rates for emergency physicians in the state’s Medicaid program, Medi-Cal. Emergency physician Medi-Cal rates have not been raised in 23 years. The rates, running as low as 60% to 54% of Medicare, are dramatically impacting access to care for patients and the long-term sustainability of our emergency physician workforce in CA.

The California Legislature is considering a historic increase to Medi-Cal reimbursement rates as part of a Managed Care Organization (MCO) tax in the 2023-24 state budget. They are discussing raising rates for primary care providers and mental health providers to 87% of Medicare. 

CalACEP members: urge your state legislators and Governor Gavin Newsom to include emergency physicians in the rate increases. 

To share legislative activity happening in your state, contact Christopher Johnson. Check out the state legislation that is currently identified and being tracked by ACEP:

• Scope of Practice
• Violence Against Healthcare Workers
• ED Boarding and Crowding
• Private Payer/Insurance
• All Other Bills

ACEP recently launched the Advocacy Leaders Program to support emergency physicians interested in taking their engagement and advocacy with federal legislators and staff to the next level. If you are interested in joining or already have a relationship with a federal legislator, complete this short form to receive more information.

Thank you to Drs. Augusto Cigliano, John Corker, Marc Futernick, Gary Gaddis, Jeffrey Goodloe, Carl Heine, Marilyn Heine, Jamie Kuo, Chip Pettigrew, Angel Rochester, Nathaniel Schlicher, Ryan Stanton, and David Wilcox for completing the second program action and contacting your U.S. Representative to sign on to the bipartisan Congressional “Dear Colleague” letter urging the Administration to swiftly convene an ED Boarding Task Force with broad stakeholder representation. If you contacted your Representative to sign on to the letter before it closed last week, let us know. 

Today ACEP submitted our response to the Centers for Medicare and Medicaid Services’ (CMS’) “Clarifying Eligibility for a Qualified Health Plan Through an Exchange, Advance Payments of the Premium Tax Credit, Cost-Sharing Reductions, a Basic Health Program, and for Some Medicaid and Children's Health Insurance Programs” proposed rule. In this rule, CMS is proposing to no longer exclude Deferred Action for Childhood Arrivals (DACA) recipients from the “lawfully present” definition, a requirement of enrollment eligibility for Qualified Health Plans through an Exchange, potentially expanding the proportion of insured individuals, as DACA recipients would be newly eligible to enroll in Medicaid and CHIP programs. ACEP is supportive of this proposal as an increase in the insured percentage of the population, which this policy indicates, will improve overall health outcomes.