The AAEM Action Report

AAEM leaders and I Street Advocates have continued to advocate for our due process bill, The Physician and Patient Safety Act. In late November, I Street Advocates met with the GOP DOC Caucus Staff Director about the bill. I Street Advocates also continues to engage with Senator Marshall’s staff about sending a letter to CMS to implement the bill administratively.

AAEM members, AAEM staff, and the I Street team have now met with the Health, Education, Labor, and Pensions (HELP) Committee Democratic staff and health staffers from Ranking Member Bernie Sanders’ (I-VT) office three times to discuss their ongoing investigation into TeamHealth. The first meeting included AAEM leadership and the next two meetings included AAEM members who are TeamHealth employees. During the first two meetings, the I Street team briefly touched on due process. HELP Committee engagement continues. 

Senators Elizabeth Warren (D-MA) and Jim Banks (R-IN) had planned to introduce the Corporate Practice of Medicine (CPoM) bill in November. We have been heavily engaged on the bill working on multiple draft iterations. At this time, Senator Banks is reviewing the bill components again to determine his next steps. Over the past month, I Street has met with Senator Banks, on the member level, and has scheduled a follow-up with his health staff for early January. We also met with Senator Warren’s health staff this week to discuss how to move the bill toward introduction. Finally, we have engaged in grassroots efforts on the bill to encourage Senator Banks to move forward with introduction.

The ACA premium tax credits (PTC) were scheduled to expire at the end of 2025. Since the government shutdown ended, Congress has considered and voted upon various approaches to the issue.

The Senate HELP Committee convened a hearing on December 3rd to evaluate different proposals to address health care costs. The hearing did not resolve the issues around PTCs, which were a large topic of the hearing. HELP Chair Bill Cassidy, MD (R-LA) focused on a health savings account alternative. Ranking member Bernie Sanders (I-VT) discussed his Medicare-for-All proposal. Other Committee members raised various health proposals they championed such as price transparency, negotiated rates, and Pharmacy Benefit Manager (PBM) reform.

On December 11th, the Senate considered competing proposals to address this issue. The Senate voted 51-48 to reject a Republican proposal to expand health savings accounts as an alternative to the subsidies. The Senate also voted 51-48 against a Democratic led proposal to extend PTCs.

On December 16th, the House Rules Committee defeated a Republican moderate amendment from Rep. Brian Fitzpatrick (R-PA) to include a PTC extension in the House Republican health bill. The Rules Committee also opposed a Democratic proposal to extend the credits for three years. The Republican leadership proposal, Lowering Health Care Premiums for All Americans, passed the Rules Committee along party lines. The Republican measure would expand association health plans by allowing employers to offer their own coverage and would codify a rule permitting employers to fund health reimbursement arrangements for workers purchasing individual-market plans.

On December 17th, the House passed the Lowering Health Care Premiums for All Americans Act in a 216-211 vote. Also, four Republican moderates signed a discharge petition led by the Democrats to force a vote on extending the PTCs for three years. The petition now has the 218 required signatures for a House floor vote. The vote will occur in January.

The above means inaction on PTCs before they expire at the end of 2025. However, a bipartisan group of approximately twenty Senators continued discussions. The group could release legislation by the end of the year, although early next month remains more likely. The House Problem Solvers Caucus, a bipartisan group of lawmakers, also met with a group of senators to discuss a path forward for the PTCs. The groups are reportedly discussing a solution which extends the PTCs, uses open enrollment, and is retroactive to January 1st.

The above update includes developments through noon on December 18th; deliberations continued beyond publication time.

Senator Bill Cassidy is continuing his oversight of the American Medical Association (AMA) Current Procedural Terminology (CPT) coding system. In a December 1st letter, Cassidy said that the AMA failed to answer prior questions about CPT fees and AMA’s use of these funds.

“I am concerned that the status quo focuses on enriching the AMA at the expense of patients, while the organization subsequently uses the revenue to advance a political agenda that is not representative of the majority of the medical community,” Cassidy said in his letter to the AMA. “Your recent response did not answer my questions that could assuage this concern.” Press reports note that the AMA will respond to the letter.

On December 9th, Senator Cassidy furthered his investigation through a press release that seeks stakeholder input. The press release said, “U.S. Senator Bill Cassidy, M.D. (R-LA), chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, is seeking information from stakeholders regarding the American Medical Association’s (AMA) monopoly of Current Procedural Terminology (CPT®) codes and its impact on patients, providers, and health care costs. Cassidy is asking stakeholders with relevant experience and knowledge of CPT ® coding contracts with the AMA to inform the Committee’s inquiry by responding to this questionnaire.”

Last Congress, Senator Cassidy and Senator Sheldon Whitehouse (D-RI) introduced legislation to create a new technical advisory committee within the Centers for Medicare and Medicaid Services (CMS) to set Medicare payments rather than the RUC. It remains possible Senator Cassidy will introduce this or related legislation next year.

On December 3rd, the New Democrats Health Care Working Group released a health plan. According to the press release, “The Health Care Action Plan lays out New Dems’ commonsense agenda to address the Republican health care crisis by lowering health care costs, expanding access to high-quality care, and protecting the programs millions of working Americans and seniors rely on.” The New Democrat Coalition includes 116 lawmakers.

Senate Finance Committee ranking Democrat Ron Wyden (D-OR) sent a letter on December 16th to several electronic health record (EHR) companies urging them to adopt stronger privacy measures to protect sensitive patient information. In response to health information leaks, Wyden said, “Such widespread access exposes patients to the threat of improper access, theft, and leaking of their sensitive health information.”

On December 5th, the Advisory Committee on Immunization Practices removed a longstanding recommendation that all U.S. infants are vaccinated against hepatitis B within 24 hours of birth. The vote was accompanied by a vigorous and lengthy debate. The press release said, “the Advisory Committee on Immunization Practices (ACIP) today voted 8 to 3 to recommend individual-based decision-making for parents deciding whether to give the hepatitis B vaccine, including the birth dose, to infants born to women who test negative for the virus. For those infants not receiving the birth dose, ACIP suggested in its recommendation that the initial dose be administered no earlier than two months of age.”

On December 5th, the White House published a memorandum regarding an effort to reexamine the full childhood vaccine schedule in an effort to revise policy to more closely resemble other countries that recommend fewer vaccines.

On December 11th, the Administration issued an executive order (EO) to limit and challenge state AI regulations.  Some health attorneys have expressed concern that the EO could impact health care-specific state AI laws.  Notably, early discussion about the EO notes that it could inadvertently regulate medical professionals, including physicians, and tools they use in their practice. Some speculated that the EO could impact the state’s role in regulating the practice of medicine. Lawyers also expect the EO to face challenges in court.

SB 435, which we opposed last month after it left the committee, remains “available for scheduling.” This is likely due to the holidays. 

DEI Lawsuit. Former federal employees of HHS and other agencies have filed a lawsuit in the D.C. district alleging the Trump administration’s reductions in force unlawfully targeted people in jobs perceived to be related to diversity, equity and inclusion as well as employees who are people of color, women or LGBTQ. According to an ACLU press release, the plaintiffs claim that “retaliating against federal employees for their perceived political views violates the First Amendment.”  The lawsuit also alleges “that the administration violated employment protections under Title VII of the Civil Rights Act.”

Vaccine Policy. The American Academy of Pediatrics and other medical professional groups filed suit against HHS Secretary Robert F. Kennedy Jr. to demand his ACIP selected advisors be dismissed as the appointments were arbitrary and capricious. The case was brought in the District of Massachusetts. Notably, the Washington Post reported on December 16th that the Department of Health and Human Services has terminated seven grants totaling millions of dollars to the American Academy of Pediatrics, including for initiatives on reducing sudden infant deaths, improving adolescent health, preventing fetal alcohol syndrome and identifying autism early.