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What Does the New US Budget Law Mean for Physicians?
What Does the New US Budget Law Mean for Physicians?

Medscape

time16-07-2025

  • Health
  • Medscape

What Does the New US Budget Law Mean for Physicians?

Physicians are still assessing the impact of the budget and policy package passed by Congressional Republicans and recently signed into law by President Donald Trump. The legislation makes the largest cuts to Medicaid in its history, eliminating about $1 trillion over 10 years and establishing a work requirement that could force many recipients off the program over bureaucratic hurdles. Nearly 12 million Americans are expected to lose health coverage over 10 years as a result, according to the Congressional Budget Office. Millions more will be affected by the law's ending of certain health insurance subsidies created under the Affordable Care Act. Here's what physicians should know: Medicare Pay Bump In the near term, physicians will see a 1-year 2026 temporary increase of 2.5% in a rate used in determining Medicare's payments to clinicians. Despite that bit of good news, the budget package will make it more challenging to practice medicine, Bobby Mukkamala, MD, president of the American Medical Association (AMA), told Medscape Medical News in an interview. Clinicians, hospitals, and medical groups are likely to have to provide more uncompensated care to the uninsured. 'When it comes to healthcare in this country and the training for healthcare in this country, I don't see anything to be happy about,' Mukkamala said. Medicaid patients made up about 17% of the average physician's caseload in 2016, according to the AMA's Physician Practice Benchmark Survey. But pediatricians, with the largest average Medicaid patient share of any specialty at nearly 35%, could see a bigger reimbursement hit, depending on whether they are on salary or not. Psychiatrists and emergency medicine physicians also have above average Medicaid patient shares (26% and 22%, respectively). Internists reported the lowest Medicaid patient share at just under 12%. New Med Student Loan Limits The new law also limits federal loans for professional programs including medical and dental school to $50,000 a year with a total cap of $200,000. The average medical school debt tops $234,000, according to an Education Data Initiative report, but tuition and living expenses for private schools can top $87,000 per year. The Association of American Medical Colleges (AAMC) said in a statement that the budget package's elimination of the Grad PLUS loan program 'will affect many prospective medical and other health profession's students and worsen the nation's persistent doctor shortage.' AAMC leaders said they were 'dismayed' by 'massive cuts to Medicaid and changes to state health insurance marketplace exchanges that will lead to tens of millions of people losing much-needed healthcare coverage.' Anders Gilberg, senior vice president for government affairs for the Medical Group Management Association, said the newly cleared bill 'paints a grim future for America's physician practices by stripping healthcare coverage from millions of Americans.' People who lose healthcare coverage 'will still find care in our US healthcare system,' Gilberg said, but 'medical groups and hospitals will be left picking up the enormous tab.' 'With these historic Medicaid cuts, dedicated physicians and medical practices committed to providing care in our country's most underserved areas will face growing financial burdens as they are forced to offer more and more uncompensated care,' he said. A Boost for Direct Primary Care The budget package also for the first time allows patients to use their Health Savings Accounts to pay for monthly fees charged by direct primary care providers, which may include office visits but not major procedures, lab tests, or prescription drugs. Monthly fees of up to $150 ($300 per couple) will be allowed and will be tied to inflation going forward. The provision is seen as a win for the growing direct primary care movement. Uninsured Concerns It's not yet clear how many adults will eventually lose health coverage due to the implementation of the new law. The Congressional Budget Office had estimated that 11.8 million fewer people would have had health insurance in 2034 if an earlier Senate version of the bill were adopted. Belinda R. Avalos, MD, president of the American Society of Hematology said in a statement that nearly half of people living with sickle cell disease are covered under Medicaid or the Children's Health Insurance Program. 'It is profoundly disappointing that the Senate and House have voted to adopt the devastating cuts to Medicaid outlined in this bill,' Avalos said. 'These cuts recklessly endanger the health of millions of Americans, including those living with complex, life-threatening blood disorders.' In a statement, the American College of Rheumatology (ACR) said it also was 'disappointed that Congress has advanced legislation that could impact patients' access to Medicaid and limit providers' ability to care for vulnerable patients.' 'We encourage leaders in Washington to support measures that expand access to care and coverage for patients, rather than displacing the estimated 11.8 million Americans whose insurance could be at risk,' ACR said.

AMA warns med school loan cap could worsen doctor shortage
AMA warns med school loan cap could worsen doctor shortage

Axios

time14-07-2025

  • Health
  • Axios

AMA warns med school loan cap could worsen doctor shortage

The Chicago-based American Medical Association is warning that the doctor shortage in the U.S. could get worse with Congress' new megabill. Why it matters: Even before the legislation passed, the AMA was predicting the U.S. would have a shortage of more than 85,000 doctors by 2036. The latest: The spending bill signed by President Trump this month will cap medical school loans at a total of $200,000, but the average med school debt is more than $210,000, according to the AMA. The cost of a public, in-state medical school was as high as $286,000 in 2024 and more than $390,000 for private institutions. What they're saying: AMA president Bobby Mukkamala called the legislation "disappointing, maddening, and unacceptable." Between the lines: Med students who exceed the new cap and need to take out private loans won't be eligible for public service loan forgiveness, which allows graduates to have their federally borrowed student debt forgiven after 10 years if they work at a nonprofit, which many hospital systems are. By the numbers: Illinois has nearly 700 Health Professional Shortage Areas (HPSAs), which encompass primary, dental and mental health care professionals. The government determines these designations based on the population-to-provider ratio, percent of population below 100% of the federal poverty level (FPL) and travel time to the nearest source of care. Fewer health care professionals mean less access to care, leaving the state with nearly 150 areas that are considered medically underserved, including 41 in Cook County, that have too few primary care providers, high infant mortality, high poverty or a high elderly population. Threat level: One in five physicians hope to leave their practice in the next two years, one in three want to reduce hours and 40% of medical students may not want to enter clinical practice, according to the AMA. Zoom out: The association has also been vocal in its opposition to Medicaid cuts in the spending bill, for the damage it will do to patient care and the medical profession, they argue. Medicaid cuts will total about $930 billion over the next decade, and nearly $50 billion in Illinois during that period, according to a KFF analysis. "The cuts to federal health care programs, including Medicaid and CHIP, will shift costs to the states and specifically to physicians and hospitals to provide uncompensated care at a time when rural hospitals and physician practices are struggling to keep their doors open," the AMA said in a statement. The other side: Trump and Republicans, many of whom still see Medicaid coverage as an "entitlement program," maintain the cuts will save the government $1 trillion over the next decade, though the Congressional Budget Office expects the bill will add $3.3 trillion to the national debt over 10 years.

Healthcare groups blast passing of Trump's tax bill, warn it will harm millions
Healthcare groups blast passing of Trump's tax bill, warn it will harm millions

Time of India

time04-07-2025

  • Health
  • Time of India

Healthcare groups blast passing of Trump's tax bill, warn it will harm millions

Healthcare groups slammed the passage of U.S. President Donald Trump's tax-cut and spending bill on Thursday, warning that its sweeping healthcare provisions would inflict widespread harm on millions of Americans. The bill, when enacted, will overhaul the government's Medicaid healthcare program that covers around 71 million low-income Americans, introducing changes including mandatory work requirements that are expected to leave nearly 12 million people uninsured, according to the Congressional Budget Office . Republicans have said the legislation will lower taxes for Americans across the income spectrum and spur economic growth. According to the CBO, the bill would lower tax revenue by $4.5 trillion over 10 years and cut spending by $1.1 trillion. Much of those spending cuts come from Medicaid. Bobby Mukkamala, president of the American Medical Association, an influential U.S. doctors' group, warned that the Medicaid cuts would limit access to care by leaving millions without health insurance and make it harder for them to see doctors. "It will make it more likely that acute, treatable illnesses will turn into life-threatening or costly chronic conditions. That is disappointing, maddening, and unacceptable," he said. The Alliance of Community Health Plans, which represents local, nonprofit health plans, also rebuked the bill's passage, saying it would drive up consumer costs while slashing federal health spending to historic levels. The group pledged to work with policymakers to minimize disruption for communities. Greg Kelley, president of the Service Employees International Union's healthcare branch, representing Illinois, Indiana, Missouri, and Kansas, called the bill a "moral failure" that threatened healthcare access, jobs, and the stability of the healthcare system. Craig Garthwaite, director of the healthcare program at Northwestern University's Kellogg School of Management, said their research showed such cuts would hurt patient health. He said expanding Medicaid had saved lives and cutting it back was likely to have the opposite impact. Ge Bai, a Johns Hopkins health policy professor and adviser to the conservative Paragon Health Institute, said she expected the private market would step in as able-bodied adults lose Medicaid and subsidies.

Healthcare groups blast passing of Trump's tax bill, warn it will harm millions
Healthcare groups blast passing of Trump's tax bill, warn it will harm millions

Reuters

time03-07-2025

  • Health
  • Reuters

Healthcare groups blast passing of Trump's tax bill, warn it will harm millions

July 3 (Reuters) - Healthcare groups slammed the passage of U.S. President Donald Trump's tax-cut and spending bill on Thursday, warning that its sweeping healthcare provisions would inflict widespread harm on millions of Americans. The bill, when enacted, will overhaul the government's Medicaid healthcare program that covers around 71 million low-income Americans, introducing changes including mandatory work requirements that are expected to leave nearly 12 million people uninsured, according to the Congressional Budget Office. Republicans have said the legislation will lower taxes for Americans across the income spectrum and spur economic growth. According to the CBO, the bill would lower tax revenue by $4.5 trillion over 10 years and cut spending by $1.1 trillion. Much of those spending cuts come from Medicaid. Bobby Mukkamala, president of the American Medical Association, an influential U.S. doctors' group, warned that the Medicaid cuts would limit access to care by leaving millions without health insurance and make it harder for them to see doctors. "It will make it more likely that acute, treatable illnesses will turn into life-threatening or costly chronic conditions. That is disappointing, maddening, and unacceptable," he said. The Alliance of Community Health Plans, which represents local, nonprofit health plans, also rebuked the bill's passage, saying it would drive up consumer costs while slashing federal health spending to historic levels. The group pledged to work with policymakers to minimize disruption for communities. Greg Kelley, president of the Service Employees International Union's healthcare branch, representing Illinois, Indiana, Missouri, and Kansas, called the bill a 'moral failure' that threatened healthcare access, jobs, and the stability of the healthcare system. Craig Garthwaite, director of the healthcare program at Northwestern University's Kellogg School of Management, said their research showed such cuts would hurt patient health. He said expanding Medicaid had saved lives and cutting it back was likely to have the opposite impact. Ge Bai, a Johns Hopkins health policy professor and adviser to the conservative Paragon Health Institute, said she expected the private market would step in as able-bodied adults lose Medicaid and subsidies. "These people will come back to the private market," she said. "The financial burden to purchase insurance will be shifted away from U.S. taxpayers to these people's shoulders."

AMA Calls for ACIP Answers, Stable Federal Funding
AMA Calls for ACIP Answers, Stable Federal Funding

Medscape

time13-06-2025

  • Health
  • Medscape

AMA Calls for ACIP Answers, Stable Federal Funding

Leaders and delegates at this week's American Medical Association (AMA) annual meeting called for more stable funding for medical care and research, and a US Senate investigation into unprecedented changes to a federal vaccine advisory panel. AMA delegates passed an emergency resolution asking for that investigation after US Department of Health and Human Services Secretary Robert F. Kennedy Jr earlier this week removed all 17 members of the Advisory Committee on Immunization Practices (ACIP), replacing them with eight new members, some regarded as vaccine skeptics. The resolution also directs AMA to send a letter asking Kennedy to immediately reverse the changes. Jason M. Goldman, MD, president of the American College of Physicians said at the meeting that Kennedy's action puts at risk insurance coverage for vaccines. ACIP's recommendations influence insurance coverage and vaccine uptake. 'As physicians, we must be the voice for our patients,' said Goldman. 'We must be the voice for science, evidence, and knowledge, and we must make sure that our institutions are protected.' Other delegates pressed the AMA to fight back against deep cuts to federal funding for healthcare and medical research. In his inaugural speech on Tuesday as AMA president, Bobby Mukkamala, MD, an otolaryngologist, said the 'importance of access to physician care is very much on my mind.' 'We cannot lose sight of what medicine and science have achieved in our lifetimes, and we cannot abandon this progress and endanger the health of millions whose illnesses could have been treated had we stayed on course,' Mukkamala said. Congressional Republicans have proposed cutting Medicaid spending and reducing subsidies for plans sold by exchanges created by the Affordable Care Act. Separately, the Trump administration has proposed a roughly 40% cut, or almost $18 billion, in the annual funding of the National Institutes of Health for fiscal 2026, the budget year starting in October. Mukkamala also called for efforts to reduce the administrative burden of prior authorization and to address Medicare physician payments, which have not kept up with inflation in recent years. More Transparency for Artificial Intelligence (AI) in Medicine The AMA also adopted policies regarding AI-driven tools and guidance for physicians regarding corporate investment in their practices. One policy calls for independent third parties to determine whether an AI tool for clinicians is 'explainable' — that it can explain to users its decisions and the evidence behind them. The new AMA policy calls for more transparency regarding these tools, including disclosure of their algorithms. Physicians at the conference raised concerns about AI-based tools making errors that could potentially harm patients and leave clinicians liable for the tools' flaws. AMA members' concerns included the potential for AI hallucinations about billing codes to leave a busy physician at risk for allegations of fraud. Among those who pushed for the AMA to adopt new policies on AI-driven tools was Jennifer Bryan, MD, chair of the Mississippi delegation to the AMA and president of the Mississippi State Medical Association. Decisions made at this AMA meeting will help physicians know when 'AI informs clinical decisions and exactly how confident the AI is in its recommendations,' Bryan told Medscape Medical News in an email. 'This is a big step forward in not just setting standards today but shaping responsible AI practices in medicine for years to come.' Corporate Intrusion The AMA delegates also voted to strengthen guidance for physicians regarding corporate or private equity investment in their practices. Corporate investment can offer an alternative to selling a practice to a hospital or health system, AMA said. These kinds of arrangements can include private or public for-profit companies, investment firms, and insurance companies. Physicians may benefit from these arrangements by being freed of some business and administrative responsibilities to spend more time with patients. But such arrangements may also pose risks, including the loss of independent authority over clinical decisions and operations, the AMA said. AMA's updated guidance recommends that decisions that should remain in the ultimate control of the physicians partnered with other entities include: Determining which diagnostic tests are appropriate for patients. Determining the need for referral or consultation with another clinician. Determining how many patients a physician should see or how many hours a physician should work. Determining the content of patient medical records. Making decisions regarding coding and billing procedures for patient care services.

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