June 20, 2025: National Advocacy Update

On June 20, the American Medical Association (AMA) sent a letter (PDF) to Majority Leader Thune (R-SD) and Minority Leader Schumer (D-NY) outlining our concerns with the Senate version of the One Big Beautiful Bill Act (H.R. 1). In its comments, the AMA highlights its concerns on legislative language regarding Medicaid and the Children's Health Insurance Program (CHIP), access to health insurance coverage through the Affordable Care Act marketplaces, support for medical student loans, a 10-year moratorium on state-level regulation of AI, and the lack of inclusion of the House-passed Medicare physician payment reform provisions.

In the letter, the AMA stresses that Medicaid is a vital component of America's health care infrastructure, providing health insurance coverage to millions of patients and serves as a critical safety net for children, pregnant and postpartum women, seniors, and people with disabilities and serious health conditions. While the AMA is supportive of legislative efforts to address program integrity, the changes included in the Senate Reconciliation package would result in reductions in Medicaid and CHIP funding, potentially leading to coverage disruptions or new obstacles to physicians and other health care providers. AMA policy is that Medicaid reforms should avoid jeopardizing patient access to health care.  

Additionally, the Senate Reconciliation package did not include language that would permanently link annual physician fee schedule updates to the Medicare Economic Index. Physicians are already facing a 2.83 percent cut to Medicare payment in 2025, and since 2001, payment updates have fallen behind practice cost inflation by 33 percent. This is not sustainable. The AMA is continuing to work to make sure that this provision is reinstated and included in a final legislative package. 

On June 18, the AMA sent a letter (PDF) to Secretary of State Marco Rubio regarding J-1 appointments for foreign national physicians which were paused by the U.S. Department of State. The AMA House of Delegates adopted Resolution 237-A-25 in response to concerns over this pause. Shortly after the AMA's letter was submitted, the Department of State announced that interviews for visas will no longer be paused and that interview availability for physicians will be prioritized, due to the approaching July 1, 2025, residency start date. Intealth, parent organization of the Educational Commission for Foreign Medical Graduates (ECFMG), the universal sponsor for J-1 physicians, has worked aggressively over the past few weeks to provide an exception and prioritization for physicians throughout this interview pause that began in May of 2025. The AMA has been in constant contact with and supported ECFMG in this effort. 

At the end of May, the U.S. Department of Health and Human Services (HHS) and Food and Drug Administration (FDA) made multiple announcements regarding review and recommendations for COVID-19 vaccinations. On May 20, the FDA in the New England Journal of Medicine announced the agency would require new randomized controlled trials (RCT) for COVID-19 vaccinations for certain populations, including those up to age 65 that are not in a high-risk category. While it remains to be seen how this ultimately impacts vaccine access among all populations, it could result in a lack of any available COVID-19 vaccines for healthy populations under the age of 65.  

Additionally, on May 27, HHS, along with FDA and the National Institutes of Health (NIH), announced a change in recommendations for COVID-19 vaccinations. These changes included removing recommendations for COVID-19 vaccination for healthy children and for pregnant women. Days later, HHS again revised the recommendations to state that healthy children and pregnant women could receive the vaccine after consultation with their physician. Neither the FDA decision nor the revised Centers for Disease Control and Prevention (CDC) vaccination schedule recommendations were made in consultation with their respective advisory committees.  

Following the announcements, the AMA sent a letter to HHS Secretary Robert F. Kennedy, Jr. (PDF) raising concerns with the policy changes at both FDA and the CDC and urging both agencies to engage the public through both the advisory committee process and through opportunities for public review and comment prior to finalizing any changes to these critical policies. The AMA also raised serious ethical concerns with the use of RCTs for existing vaccines and with the implications for coverage for COVID-19 vaccination should CDC remove their vaccine recommendations for healthy children and pregnant women. The AMA will continue to monitor these evolving policy changes. 

On May 30, HHS released its long-awaited Budget-in-Brief, providing additional detail and context to the summary received by Congress earlier this spring. Additionally, some agencies, including the FDA, released their full budget requests. Others, including the NIH and the CDC, have yet to post their budget requests.  

The FY 2026 HHS Budget-in-Brief outlines a series of significant cuts to HHS and its agencies, proposing to reduce the overall HHS budget by over $30 billion. HHS is requesting significant cuts of $18 billion to NIH and proposes a significant reorganization of its institutes and centers, collapsing the current structure down to only eight. Additionally, the budget proposes a massive reorganization of several current HHS agencies to further the president’s goal of creating the Administration for a Healthy America (AHA). The proposed creation of the AHA would see most remaining functions from the Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, and several CDC functions moved to AHA while several functions within each agency would be eliminated entirely.  

The Budget-in-Brief also proposes some reorganization within the Department itself, creating a new Office of Strategy, which would house some remaining functions from the Agency for Healthcare Quality and Research, and the Assistant Secretary for a Healthy Future. A new General Department Management effort would house the department’s proposed Chief Technology Office and HHS technology and cybersecurity policy efforts. 

The FY 2026 budget proposal will now be reviewed by the House and Senate Appropriations Committees, who will ultimately decide on funding levels for federal programs and any potential reorganization of HHS. The AMA will continue to monitor the appropriations process as the HHS appropriations efforts are not expected to be reviewed until later this summer. The AMA will weigh in as appropriate during the process. 

Physicians can now preview their 2023 Merit-based Incentive Payment System (MIPS) performance information as it will appear later this year on the compare tool on Medicare.gov and in the Provider Data Catalog (PDC). Upon reviewing MIPS performance information and finding any errors, physicians may file a targeted review but must do so by June 25. Eligible physicians also now have the option to opt out of having MIPS data publicly posted but only have until June 25 to inform the Centers for Medicare & Medicaid Services (CMS). Publicly reported information includes MIPS and Qualified Clinical Data Registry quality measures, MIPS Promoting Interoperability measures and attestations, and MIPS improvement activities attestations. More information is available in these overview documents on the preview period (PDF) and public reporting (PDF).

Access to the secure preview is available on the QPP website through June 25, 2025, at 8 p.m. Eastern time. For questions about how to access the preview or public reporting on the compare tool on Medicare.gov, contact the QPP Service Center by emailing QPP@cms.hhs.gov, submitting a QPP Service Center ticket, or calling 1-866-288-8292 (Monday–Friday, 8 a.m.–8 p.m. Eastern time). 

The AMA was encouraged that the U.S. House of Representatives overwhelmingly passed by a vote of 366 to 57 H.R. 2483, the SUPPORT for Patients and Communities Reauthorization Act of 2025, legislation that reauthorizes billions of dollars in federal funding to help combat the opioid crisis, on June 4.  Introduced by Representatives Brett Guthrie (R-KY), chair of the Energy and Commerce Committee and Representative Brittany Pettersen (D-CO), this legislation reauthorizes many parts of a previous original opioid-centric bill that passed in 2018 but ultimately expired in 2023. 

AMA strongly supported (PDF) H.R. 2483 immediately following its passage out of the House Energy and Commerce Committee in late April. In particular, the AMA highlighted support for the legislation because, among other things, it: 

• Continued support for many state-level programs that recognize the complicated nature and scope of the overdose epidemic and polysubstance use 

• Included substantial federal funding designed to supplement, rather than supplant, state funding 

• Reauthorized programs dedicated to prenatal and postnatal health, including for pregnant and postpartum women with opioid use disorder or who are receiving medications to treat opioid use disorder 

• Included provisions to help improve access to addiction medicine providers 

• Supported funding for alternatives to opioid therapy 

• Corrected a previous legislative unintended consequence to now authorize delivering controlled substances by a pharmacy to a prescribing practitioner 

The AMA looks forward to continuing to work with the U.S. Senate to advance this particular bill in hopes of completing the long-stalled process of reauthorizing the SUPPORT Act. 

Bipartisan legislation was introduced in the House of Representatives on June 10 to both eliminate the current cap on graduate medical education (GME) and provide relief to the ongoing physician workforce crisis in the United States. Representatives Terri Sewell (D-AL) and Brian Fitzpatrick (R-PA) reintroduced H.R. 3890, the Resident Physician Shortage Reduction Act (PDF), which increases the total number of Medicare-supported GME slots by 14,000 over a period of seven years.   

More specifically, the bill awards 2,000 total residency slots per year between 2026 and 2032. Despite targeted exceptions, no hospital, in general, can receive more than 75 slots each year. In addition, new provisions in the legislation ensure that no less than 10 percent of the annual GME slots should be distributed to rural hospitals. The bill retains provisions that require the Secretary to give priority to hospitals that are affiliated with a historically Black medical school. Last Congress, the Resident Physician Shortage Reduction Act generated 222 bipartisan House (189 Democrats and 33 Republicans) and 18 bipartisan Senate cosponsors (16 Democrats, 2 Republicans) in the 118th Congress. 

“The American Medical Association [AMA] commends Reps. Terri Sewell (D-AL) and Brian Fitzpatrick (R-PA) for once again introducing this crucial bipartisan legislation that aims to address the growing physician shortage and resulting access challenges for patients,” said AMA Immediate Past President Bruce A. Scott, MD. “As more Americans become eligible for Medicare each year, the demand for physician care continues to rise. This bill—by expanding federal support for graduate medical education over the next seven years—represents a critical step toward ensuring patients nationwide have access to well-trained physicians in their communities." 

The Association of American Medical Colleges (AAMC) estimates that the United States is facing a projected shortage of up to 86,000 physicians by 2036. A recent Viewpoint story by AMA President Bobby Mukkamala, MD, “The physician shortage will worsen—unless Congress acts now,” provides more details. Senators John Boozman (R-AR) and Raphael Warnock (D-GA) are expected to introduce a Senate companion bill in the coming months.   

AMA looks forward to working diligently to add additional House cosponsors, as well as the Congressional leads to advance it through both chambers in the 119th Congress. 

Two manufacturers of buprenorphine have changed their labels following FDA recommendations and clarify that there is no maximum daily dose of buprenorphine to treat opioid use disorder (OUD). 

As explained by the American Society of Addiction Medicine (ASAM), “The label update follows the Food and Drug Administration’s (FDA) Dec. 2024 recommendation that transmucosal buprenorphine product labels be updated to address misperceptions of a daily maximum dose of 16 or 24 milligrams (mg). Instead, practitioners should take a patient-centered approach and adjust dosages based on the patient’s therapeutic needs and responses. For some patients, doses higher than 24 mg may be appropriate.”  

The label changes align with AMA policy and advocacy for “federal agencies, manufacturers, medical organizations, and health plans to review the evidence concerning buprenorphine dosing and revise labels and policies accordingly, in light of increasing mortality related to high-potency synthetic opioids.”  

The AMA urges all payers to update their own policies to remove restrictions on buprenorphine that are tied to daily dosage limits. 

Read more about AMA advocacy on this issue. 

For additional clinical information, read "ASAM’s clinical considerations: Buprenorphine treatment of opioid use disorder for individuals using high-potency synthetic opioids." 

The AMA recently commented (PDF) in response to a Request for Information (RFIs) from CMS on deregulation. AMA comments touched on several topics including prior authorization and step therapy requirements, MIPS reforms, audits, telehealth, electronic payments and more. The letter focused on highlighting opportunities within CMS’ statutory authority where it could streamline regulatory requirements while reducing burdens on physicians and practices. This is one of several recent RFIs the AMA has responded to on the topic of deregulation, and the AMA will continue to advocate on many of these areas with the new administration in the coming months.  

The AMA recently submitted comments (PDF) in response to the 2026 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System (IPPS) proposed rule. In its comments, the AMA reiterated earlier concerns about the Transforming Episode Accountability Model (TEAM) including its flawed payment and quality reporting methodologies, along with lack of supports for rural, safety net, and other types of vulnerable hospitals which could exacerbate existing access issues in those communities. The AMA strongly pushed back against the concept of mandating participation in models that essentially force savings through payment cuts and called for a delay to redesign the model to address stakeholder concerns. Among other topics covered in its letter, the AMA also offered suggestions to improve several quality and promoting interoperability reporting requirements. 

The AMA provided feedback (PDF) to CMS on its Health Technology Ecosystem Request for Information that sought stakeholder input to accelerate secure, patient-centered data exchange and promote digital health tools for Medicare beneficiaries while easing the administrative and financial burdens that hinder physicians’ ability to provide care. In conjunction with its work with the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), CMS is focused on increasing beneficiary access to the effective digital capabilities needed to make informed health decisions, and increasing data availability for all stakeholders contributing to health outcomes. 

The AMA's response welcomed CMS’ exploration of consumer-facing digital assistants and care-navigation apps that can handle the administrative chores patients find most frustrating, including coordinating specialist appointments and appealing insurance denials. In addition, the AMA also commented on how artificial intelligence (AI)-enabled tools may be able to reduce administrative friction for both patients and physicians as well as streamline access to care but should follow six guardrails to ensure that these tools do not erode trust. The AMA’s letter also presented several important features to make accessible digital-health tools easy to use for Medicare beneficiaries and caregivers, including reliable connectivity, clear instructions, and device features that synchronize seamlessly with clinical workflows.  

The AMA applauded CMS’ goal of empowering patients to flag true information-blocking incidents, and encouraged CMS and ASTP/ONC to embed a one-click “Report a sharing problem” button in every certified patient portal and Blue Button–enabled apps that route complaints first to the practice (so physicians can clarify or correct the request) and, if unresolved, forwards the report—and relevant log files—directly to ASTP/ONC’s portal with the developer clearly identified. The AMA letter also urged requirements around developers posting plain-language, in-portal notices explaining patients’ access rights, the difference between physician and developer responsibilities, and step-by-step instructions (including a toll-free hotline with live assistance) for filing a complaint with the developer.  

On June 11, the Administrator for the Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, turned 65 and used the occasion to share information to the public regarding the Medicare enrollment process. Dr. Oz and CMS released a series of educational videos and social media content (via X, Instagram, & Facebook) encouraging Americans approaching age 65 to explore their coverage options, compare plans, and utilize trusted tools like Medicare.gov to make informed decisions about their health care. Dr. Oz also highlighted the steps that individuals should take when evaluating Traditional Medicare (TM) and Medicare Advantage (MA), selecting prescription drug coverage, and exploring supplemental insurance to avoid gaps in care or unexpected costs.  

The AMA has long advocated for more clear and proactive communication around Medicare enrollment requirements to help facilitate timely enrollment, prevent beneficiaries from unknowingly incurring penalties, and avoid gaps in insurance coverage or permanent increases in Part B premiums. In an April 2025 letter (PDF) to CMS, the AMA urged CMS and the Social Security Administration (SSA) to significantly expand outreach efforts to ensure that individuals are informed about Medicare Part B enrollment timelines and the risk of penalties—well in advance of turning 65. The letter also recommended that CMS and SSA create a comprehensive Medicare-eligibility checklist to guide people through the steps they should take before and during their enrollment window, including key decision points, important deadlines, risks of delayed enrollment, and guidance on choosing between Medicare coverage options. The AMA is supportive of the recent efforts by Dr. Oz and CMS to provide greater public awareness around the Medicare enrollment process and continues to encourage further outreach and additional resources to ensure comprehensive understanding of critical information. 

The AMA submitted comments (PDF) to the FDA on a recently proposed rule which would require most foods to display a nutrition facts information label on the front of the package regarding the relative levels of saturated fat, sodium and added sugars in a serving of food. Overall, the AMA was supportive of such a requirement, noting that providing contextual and interpretive information about the relative significance of these nutrients in the context of a total daily diet will help consumers quickly and easily identify foods that are part of a healthy diet and compare products, as well as protect consumers against potentially misleading claims while not overwhelming them with too much information. However, the AMA was somewhat critical of FDA’s proposed new definitions for foods that were “high” “medium” or “low” in fat, sodium, and added sugar, asking the FDA to cap “high” at 10% daily value instead of 20% as proposed, to ensure standards were sufficiently rigorous and in line with daily recommended limits. 

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