AAFP urges Senate to stave off ‘tsunami’

As we told the House while committees there drafted this package, decreased investment in the Medicaid program, especially at the scale now being proposed, risks the stability of that program—a stability on which so much else in the broader health care landscape depends.

“It will not just be Medicaid beneficiaries who are impacted when rural and safety-net hospitals close, physicians retire or practices shut their doors,” we said in the May 29 letter. The privately insured as well as patients on Medicare will feel their care access shaken. These Medicaid cuts, especially in tandem with other policy changes proposed in the so-called One Big Beautiful Bill Act, “have the potential to harm the family physician workforce and patients’ access to essential, comprehensive primary care,” we said.

Physician payment and medical student debt

Our Senate guidance carries forward endorsements of certain provisions in the package that we shared with the House.

In a potential win for our advocacy, one section of the bill would allow medical residents to defer interest on their federal student loans. And the package still has a nominal boost to Medicare physician payment, though we continue to ask that lawmakers address the 2.83% cut inflicted on family physicians this year and provide a more adequate inflationary update. But other provisions in the bill, we said, “raise significant concerns for the primary care workforce and would potentially mitigate any savings medical residents receive from interest deferment.”

Specifically, we objected to proposals in the legislation that would cap student loan borrowing and restrict participation by medical residents in the Public Service Loan Forgiveness (PSLF) program. Taken together, these changes would further contract the already diminishing primary care workforce. As we have cautioned lawmakers repeatedly this year, disrupting PSLF would prevent prospective physicians from choosing primary care. With this country facing a projected shortage of some 40,000 primary care physicians over the next decade, Congress can’t afford to abandon PSLF support for an incoming generation of family physicians and the ones beyond.

Care access 

Apart from the AAFP’s objection to a number of the package’s Medicaid-specific provisions, we also advised against parts of the reconciliation bill that would impede access to health care coverage for individuals across federal health programs (Medicaid but also Medicare and Affordable Care Act Marketplace plans) on the sole basis of a patient’s immigration status.

“The AAFP wholeheartedly believes that health care is a right for all individuals, regardless of immigration status,” we said. “Family physicians take an ethical oath that emphasizes the health and well-being of all patients. Policies that seek to limit access to vital health care services and deny basic human rights to migrant, asylee and refugee populations, documented or undocumented, are of moral concern.”

As this process further unfolds, I will keep you updated. I encourage you to take advantage of your opportunity to speak out on these issues and to consider attending our upcoming Family Medicine Advocacy Summit, where members will advocate in person to increase Medicare physician payment, safeguard Medicaid and maintain robust medical student debt relief.