FFFM | State and local advocacy at work

Welcome to Fighting for Family Medicine. I'm David Tully, Vice President of Government Relations and a member of the AAFP's advocacy team. In this episode, you'll hear how the AAFP advocated for family medicine during the month of September. Then I'll spend some time talking with a member of our government relations team on progress made for primary care during the 2026 state legislative sessions that took place across the country.

You can explore more resources related to this episode in the show notes below.

First, I want to share an important update on the AAFP's immunization efforts. As respiratory virus season gets underway, the AAFP recommends that adults get their COVID-19, flu, and RSV immunizations if eligible. Through the Vaccine Integrity Project, the AAFP works with other leading medical organizations, including the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the Infectious Diseases Society of America, to coordinate vaccine recommendations and help ensure the continuity for patients and physicians.

The AAFP developed the adult immunization schedule. We continue to maintain that vaccine recommendations should be evidence-based and that vaccines should be easy for patients to find and afford. The AAFP is also speaking out against policies that could weaken childhood and adult immunizations because vaccines remain one of the most effective tools, we have in preventing serious illness and death.

You can find a link to our full respiratory immunization recommendations in the show notes below. You can also use the Speak Out link in our show notes to urge your members of Congress to protect access to vaccines.

With that, let's turn to some of our recent legislative actions. The AAFP and physician leaders from across other medical societies were on Capitol Hill this week urging lawmakers to protect access to primary care and reduce barriers to care for patients and physicians. Our leaders called on Congress to prevent Medicare payment cuts, reform prior authorization, secure funding for community health centers and the National Health Service Corps and protect access to care in rural and under- resourced communities.

As midterm elections approach, Congress is considering several bipartisan bills that would improve access to primary care. The legislation we are focused on would reform Medicare physician payment and improve access to obstetric care in rural communities. The Patients First Act is a concrete step toward modernizing a payment system that has historically undervalued primary care.

With many counties facing maternity care shortages, the Rural Obstetrics Readiness Act would help rural facilities prepare for obstetric emergencies through training, equipment grants, and practice support. You can read our letter to Congress in the show notes below.

Shifting away from legislative activity, I'd like to take a few moments and share a few regulatory updates. The AAFP submitted comments in response to the 2027 Medicare Physician Fee Schedule Proposed Rule. Our comments highlighted support for proposals that recognize the value of primary care and encourage more comprehensive preventative care.

At the same time, we strongly oppose a proposal that would reduce payment when an evaluation and management service happens on the same day as a procedure. Family physicians know patients often bring up more than one concern in any office visit. Payment policy should support comprehensive care, not penalize it.

You can read our full comment letter in the show notes below.

The AAFP is also monitoring federal policy changes that could affect physician workforce and how physicians are trained. That includes proposed H-1B visa changes and accreditation rules that could affect health professional education. The through line here is access. Family medicine needs a strong, diverse workforce and training system to meet the needs of rural and under-resourced communities.

We will stand against any policies that make it harder for individuals to enter and stay in primary care. You can read our letter to the federal agencies in our show notes below.

We recently wrote to the Department of Education to express concern about a new proposal that would change how grants are selected and evaluated. Our letter flagged that several provisions in the proposed rule could create funding uncertainty and disadvantage medical schools, rural-serving institutions, and other programs that support physician education and workforce development.

As the government continues to implement HR 1, the AAFP is advocating against a CMS proposed rule that would largely freeze existing provider tax financing arrangements and limit states' abilities to expand Medicaid financing. The AAFP is concerned the proposal could weaken state Medicaid funding, reducing access to care for Medicaid patients, especially in rural and underserved communities.

You can read our letter in the show notes below.

The AAFP recently responded to a CMS and CDC request for information on modernizing clinical laboratory rules. The goal is to maintain quality and patient safety while avoiding unnecessary administrative burden for physician office labs. The AAFP also emphasized that AI can support care, but it should not replace physician judgment, and that cybersecurity responsibilities should be shared appropriately across the healthcare system.

You can read our full letter in the show notes below.

And with some of our legislative and regulatory updates behind us, I'd like to turn our attention to our special guest today. I'm here with Julie Harrison, Senior Manager of State Affairs and Member Advocacy, to spend a little bit of time looking back at the highlights from key state legislative actions during the 2026 calendar year.

Julie, welcome back to the podcast, and it's great to see you again.

Thanks, Dave. Glad to be here.

So, let's go ahead and start our conversation by telling our listeners what some of the key themes were during sessions across the states this year.

Good question. If I had to boil 2026 down into a few major themes, I'd say there were about four, and the most common issue across state capitals was scope of practice.

Legislators continued to consider proposals that would expand independent practice authority for non-physician clinicians. This includes nurse practitioners, physician assistants, pharmacists, and naturopaths. Family Medicine chapters spent significant time educating lawmakers about the importance of physician-led, team-based care and the role it plays in protecting patient safety and care quality.

So, in a number of states, chapters successfully defeated proposals that would have weakened the physician's oversight requirements. I think what's notable here is that this isn't just an AAFP issue. Nationally, eighty-nine percent of state medical societies, which are obviously physician-based, have identified scope of practice as a top legislative priority in 2026.

That was just one trend. Another major trend involved insurer reform, states advanced prior authorization system improvements, protections against inappropriate down-coding, improvements to utilization review processes, and new accountability measures for health plans. So, chapters also worked on network adequacy, payment dispute protections, and other safeguards against unfair insurer practices.

Thanks to our chapters, states are also increasingly recognizing that workforce shortages cannot be solved without stronger investments in family medicine. We saw efforts to expand loan repayment programs, support rural physician recruitment, provide tax incentives for preceptors, strengthen graduate medical education, and improve physician mobility through licensure reforms and non-compete restrictions.

And then one of the most exciting developments was this growing interest in primary care investment. Several states' advanced policies focused on primary care spending targets, transparency requirements, data collection, and task force charged with examining how states can better support primary care infrastructure.

And these efforts reflect the work from AAFP chapters who have spent years educating lawmakers that investing upstream in primary care leads to better outcomes, lower costs, and healthier communities So aside from these four themes, chapters also spent a lot of time on vaccination policy and maintaining evidence-based public health protections.

In addition, Medicaid financing, reimbursement, and coverage issues were especially prominent as states are grappling with budget pressures and federal policy changes. So taken together, the 2026 legislative sessions show that states are increasingly focused on the fundamentals of primary care, reducing red tape, strengthening the workforce, protecting physician-led care, improving access, and making long-term investments in the health of their communities.

So, while these sound like separate issues, they're all connected to one goal: ensuring that patients can access high-quality, comprehensive family medicine when and where they need it.

Really appreciate that overview, Julie. So maybe we could take a second and talk a little bit about where we saw some of the greatest progress taking place at the state level this year.

Yeah. So, there were really impressive victories across the country, but a few states stood out. I'm thinking particularly about Virginia. This is a state that advanced prior authorization reforms designed to reduce admin burden on physicians, and it also advanced physician workforce and access initiatives, including physician mobility reforms and limits on future physician non-compete agreements.

The Kentucky AFP also had a really big win this year in this space. Its priority bill was signed into law. It establishes a prior auth exemption gold carding program. It also requires insurers and the state Medicaid program to disclose data on prior auth activity. Illinois and Indiana also had particularly significant wins in, in the insurer reform space.

Both of these states enacted protection against inappropriate insurer down-coding. Illinois also secured clinical review requirements, specialty-matched appeals, and safeguards related to AI-assisted utilization review. These are the kind of reforms that ensure physicians are paid appropriately for the care they provide, and that clinical decisions remain grounded in medical expertise.

That's great. Talk a little bit about what we saw this past year in terms of primary care investment in the states.

Yeah. The two states that come to mind that really stood out in this space are Vermont and Delaware. Both of these states continued advancing policies focused on primary care investment, transparency, and accountability, and these efforts include collecting better, better data on primary care spending and creating structures that help policymakers evaluate whether enough resources are being directed towards primary care.

It's a recognition that stronger primary care systems lead to better health outcomes and lower overall costs. I would definitely be remiss if I didn't mention that Massachusetts is advancing major legislation, including S3116. It's an act relative to Primary Care for You, and a corresponding house healthcare affordability bill to mandate increased spending on primary care and lower overall long-term healthcare costs.

So, this is actually the direct result of a strong multi-year advocacy campaign driven by the family physicians in the state

That's great. We continue to hear a lot across the country, both at the federal and state level, about workforce shortages. This continues to be a hot topic of discussion amongst policymakers.

Workforce shortages were another major issue in the states this year. Tell me a little bit about the states that made some meaningful progress in this space. Love to hear more from your perspective about where you saw some advancements in the workforce space.

Definitely. This was another big one for our chapters this past year.

And just to name a few, we have Rhode Island, New Mexico, South Carolina, and Utah. Each of these states advanced workforce initiatives aimed at improving access to primary care. Some examples include loan repayment programs, scholarship opportunities, physician recruitment efforts, and other policies designed to make it easier for physicians to practice where they are most needed.

New Mexico also enacted major medical malpractice and liability reform legislation to address the state's physician shortage.

Great. There was obviously a lot happening in the States around physician-led care, and we talked a little bit about scope of practice at the, the beginning of our time together, and there were a number of states that took on efforts defending physician-led care.

Can you walk us through what those states were?

Yeah. One of the most important stories, I think, of 2026 was the successful defense of physician-led, team-based care. AAFP chapters in states like Kansas, Florida, West Virginia, South Carolina, Wisconsin, Maryland, and New York, just to name a few, helped defeat proposals that would've expanded independent practice authority or weakened physician oversight requirements.

These victories reinforce the importance of physician leadership in delivering that safe, high-quality patient care that we all expect. A really good example happened in West Virginia this year, where- Family physicians successfully opposed legislation that would've granted physician assistants, uh, independent practice authority, and the outcome reflected a really strong grassroots engagement and effective physician advocacy led by the West Virginia Academy of Family Physicians.

Great. Any other aspects from the 2026 legislative sessions that are worth highlighting for our listeners?

Yeah. What comes to mind, at least what I find most encouraging, is that these wins weren't concentrated in just one part of the country. They happened in blue states, red states, and purple states alike.

Whether we're talking about an issue like prior authorization or workforce development, primary care investment, or physician-led care, family physicians demonstrated that sustained advocacy can really make a difference no matter what state capital you're in.

Yeah. It's a really great reminder that some of the most important policy decisions affecting family physicians are happening at the state level.

I think there's this feeling that it's all about what's happening in DC, and what we've kind of seen from this conversation today, Julie, and a lot of the work that you've done over the last nine months, is that there's just so much that's happening at the state level, and it's so important for our members to be looped in and keyed into what's going on.

Yes. And I know you understand this better than anybody; that federal policy is always getting the headlines, right? But many of these issues that do shape the day-to-day practice are decided in the states. And in 2026, family physicians in the AAFP chapters showed that when physicians engage, they can achieve some really meaningful victories for their patients in their day-to-day practice and just the future overall of primary care.

Yeah. I'm really glad that we talked about this a little bit, and it leads to my next question, Julie. Obviously, we love that our members keep a pulse of what's going on in DC, and we certainly like reporting about the things that are happening in DC. But how do you recommend AAFP members go about keeping in touch and staying in contact with the activities that are unfolding in the states?

Good question. And, you know, the great news here is that no one has to be a policy expert to stay informed or to get involved in advocacy. And my first recommendation is to stay connected with your state chapter. The AAFP chapters are the front lines of state advocacy and provide legislative updates.

They provide their own action alerts, webinars, newsletters, and their own opportunities to engage with lawmakers. They do a tremendous amount of work to track what's happening so that their members, physicians, don't have to monitor every bill themselves. Second, I encourage all members to take advantage of AAFP's resources.

We provide state legislative backgrounders, advocacy tools, model legislation, issue briefs, and policy updates that can help physicians better understand the issues that affect family medicine. And then finally, when your chapter or the AAFP asks you to take action, consider responding. Don't just trash the email

Sometimes that means just sending a simple email to your lawmaker or making a quick phone call or even testifying on a bill and sharing your experience as a family physician. Policymakers really value hearing directly from physicians who care for patients every day. And the reality is that many of the wins that we, you know, talked about over the past ten minutes here; they have happened because family physicians have spoken up.

Lawmakers need that real-world perspective, and family physicians are often the most trusted voice in the room when decisions are being made about healthcare. So, I know I kind of got off the tracks here, but my advice is simple. Stay connected, stay informed, and don't underestimate the impact your voice can have.

Even small actions can make a meaningful difference for your patients and your practice in the future of family medicine.

And that's really a great place to leave it. Julie, thank you so much for your time and your overview, and I can say this, that we look forward to bringing you back to the podcast in 2027 as we continue to see an evolution of activity playing out at the state level.

Thank you for joining us today. You can find out what the AAFP is doing to advocate for you, your patients, and your practices, and how you can get involved by visiting our website at www.aafp.org/advocacy. Be sure to check out the show notes for more links and details to today's episode. If you've enjoyed today's episode, let us know by dropping a line to aafpnews@aafp.org​.

Be sure to share the episode with your followers on social media and tag the AAFP. We will talk to you soon.