Dear Leaders Thune and Schumer, Speaker Johnson and Leader Jeffries:
On behalf of the undersigned organizations representing physicians providing care throughout the lifespan of all in our nation—in rural, suburban, and urban communities—we write to express our deep concern for the patients we serve, the future of our health care workforce, and the sustainability of physician practices nationwide. The House-passed reconciliation bill and the recently released Senate text would have devastating consequences if enacted: stripping coverage from millions, including the most vulnerable, undermining access to medical education, and placing untenable strain on practices already struggling under financial and administrative burdens. After careful reflection and in light of the serious and far-reaching consequences, we oppose H.R. 1 and the Senate text in its current form and strongly urge Congress to reverse course.
Medicaid covers nearly 80 million people – our patients – whose continued access to lifesaving care is dependent on their ability to obtain insurance coverage. Our patients rely on Medicaid for essential care, from emergency life-saving procedures to mental health, including substance use disorders, to routine preventive services, including managing chronic conditions. Proposals that introduce work reporting requirements or shift costs to states will destabilize this coverage. The result will be more uninsured patients, increased pressure on emergency departments, and accelerated hospital closures—especially in underserved areas.
We are also alarmed by provisions impacting federal student loans. Currently, the average medical student graduates with over $235,000 in medical school debt and nearly $265,000 in total educational debt. This debt burden reflects the high cost of obtaining a medical degree, which is driven by several factors, including the need for specialized faculty, advanced clinical training infrastructure, compliance with accreditation standards, and rising institutional overhead
tied to federal and state regulatory requirements. Further, the decision to exclude medical residents from being able to participate in the Public Service Loan Forgiveness is troubling and will have direct impacts on those areas of our country with the greatest need for physicians. As written, these provisions will result in far fewer students being able to afford medical school, exacerbating the existing physician shortages across the country, especially in rural areas.
Finally, we are disheartened that once again, a major legislative proposal fails to comprehensively fix the flawed Medicare physician payment system. For years, our organizations have implored Congress to address the statutory problems with the system that have resulted in decades of stagnant or declining payments that have not kept pace with the cost of providing care. We have actively promoted a reform approach that would permanently address the 2.8 percent cut that went into effect in January, tie Medicare physician payment updates to the Medicare Economic Index, and address budget neutrality issues. Failure to do so risks the financial stability of physician practices, resulting in further consolidation and limiting patient choice.
Opposing H.R. 1 and the Senate text in its current form is not a decision we take lightly. Our commitment is to our patients and our profession. When legislative proposals threaten both, we have an obligation to speak out. We urge you to reconsider the harmful provisions in H.R. 1 and the Senate text and instead work with us to advance policy solutions that strengthen the physician workforce and ensure access to care for all patients.
Sincerely,
American College of Obstetricians and Gynecologists
American Academy of Allergy, Asthma & Immunology
American Academy of Family Physicians
American Academy of Hospice and Palliative Medicine
American Academy of Pediatrics
American College of Physicians
American Gastroenterological Association
American Psychiatric Association
American Society of Colon & Rectal Surgeons
American Society of Pediatric Nephrology
American Society for Surgery of the Hand Professional Organization
California Medical Association
Illinois State Medical Society
Massachusetts Medical Society
Medical Society of the State of New York
Society of General Internal Medicine
View a PDF version of this letter here.
