May 21, 2025
Budget must stabilize HHS, fix Medicare payment, AAFP tells House
By David Tully
Vice President, AAFP Government Relations
(Editor's note: Since this blog post was published, the House passed the budget reconciliation discussed below. On May 22, the AAFP responded with a statement calling on the Senate to safeguard access to affordable health care for millions of Americans.)
On May 19, a budget-reconciliation package (also referred to as the One, Big Beautiful Bill Act) emerged from negotiations across several U.S. House of Representatives committees. The legislation as written would cut Medicaid and related safety-net programs by nearly $800 billion and slim the Patient Protection and Affordable Care Act, among other health care provisions.
The Academy responded quickly, urging House leaders to revise proposals within the bill affecting health care access, physician payment, small practices, nutrition programs and medical education. These funding cuts and policy changes, we said, “have the potential to harm the family physician workforce and patients’ access to essential, comprehensive primary care.”
A full vote could happen in the House this week before Congress leaves town, but enactment of the package is far from settled. As written, the package would increase the federal deficit by some $50 billion—well out of step with what the Oversight Committee has in mind.
While negotiations in the House continue, we’re getting loud about our priorities, starting with that letter. I encourage you to help raise the volume even more.
Add your voice
Reconciliation package pluses and minuses
Our May 20 letter sounds several cautions but also applauds, with some caveats, other provisions in the bill. Toplining our message:
- A modest provision in the bill that would update Medicare physician payment is appreciated but does not correct the 2.83% cut that family physicians have lived with since Jan. 1. Our letter reminds lawmakers that primary care practices need an adequate inflationary update and comprehensive payment reform.
- We urge Congress not to implement the bill’s Medicaid reforms as written, which would impose work reporting requirements, more frequent eligibility verification, limits on state financing and penalties for states using their own funds to cover undocumented individuals.
- We oppose the legislation’s proposed restrictive caps on federal student loans and exclusion of medical residents from the Public Service Loan Forgiveness program, both of which will make it financially harder for physicians to pursue primary care specialties.
- We are concerned that limiting cost increases to the Thrifty Food Plan will make it difficult for SNAP beneficiaries to afford a healthy, recommended diet.
- We welcome the bill’s inclusion of the Primary Care Enhancement Act, which would allow individuals with health savings accounts to use those funds to pay for direct primary care.
- We’ve long supported the extension and expansion of the Affordable Care Act’s advanced premium tax credits (APTCs), which ensure that millions of low- and middle-income families continue to have access to affordable health coverage. These APTCs expire at the end of this year, so we again encourage Congress to incorporate APTCs into the reconciliation package.
This letter is only one element of the Academy’s multifaceted advocacy as we work to secure favorable policy on these and related matters. (Listen to this recent Fighting for Family Medicine podcast episode to learn more about the dimensions of our broader strategy.) Watch this space for updates as the budget process continues to unfold—and add your voice to the AAFP’s push.
Disclaimer
The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.