Landmark Budget Deal Delivers Eight Key Wins for Doctors and Patients
Table of Contents
- Landmark Budget Deal Delivers Eight Key Wins for Doctors and Patients
- Telehealth Access Extended, But Permanent Solution Needed
- Financial Incentives Restored for Value-Based Care
- Expanding Access to Diabetes Prevention Programs
- Addressing “Ghost Networks” in Medicare Advantage
- Hospital Care at Home Waiver Extended
- Supporting Physician Well-being Through the Dr. Lorna Breen Act
- PBM Reforms Aim to Lower Drug Costs
- Increased Funding for Maternal and Infant Health
A newly passed federal government funding package secured a bipartisan agreement on critical healthcare proposals, delivering significant benefits for both physicians and patients. The deal, finalized to avert a potential government shutdown reminiscent of the fall of 2025, addresses key priorities championed by the American Medical Association (AMA), ranging from telehealth access to physician burnout and prescription drug costs.
Telehealth Access Extended, But Permanent Solution Needed
Medicare telehealth coverage has been renewed for two years, providing a crucial continuation of services following a 43-day disruption during the 2025 government shutdown. The AMA has strongly advocated for this extension and continues to push for a permanent authorization of Medicare telehealth flexibilities. Telehealth has been proven to drive care improvement and generate cost savings, according to the AMA.
Financial Incentives Restored for Value-Based Care
A 3.1% bonus for physicians participating in Medicare alternative payment models (APMs) will be restored for one year, after expiring in 2024. This reinstatement strengthens physician engagement in APMs and value-based care by reintroducing meaningful incentives and lowering barriers to entry.
Expanding Access to Diabetes Prevention Programs
Access to the Medicare Diabetes Prevention Program will be expanded to include, for the first time, Centers for Disease Control and Prevention-recognized virtual programs on a trial basis through December 31, 2029. This expansion addresses longstanding access barriers associated with in-person participation requirements, particularly for Medicare beneficiaries in rural and underserved communities.
Addressing “Ghost Networks” in Medicare Advantage
Medicare Advantage plans will now be required to maintain accurate, regularly updated provider directories and publicly report on directory accuracy. This addresses the persistent problem of so-called “ghost networks,” where patients are unable to find in-network physicians listed in plan directories. The AMA has long called for action to provide patients with reliable information.
Hospital Care at Home Waiver Extended
The Acute Hospital Care at Home waiver has been extended for five years, running through 2030. This preserves a physician-led model that delivers hospital-level care safely in patients’ homes, demonstrably improving outcomes and patient satisfaction.
Supporting Physician Well-being Through the Dr. Lorna Breen Act
The Dr. Lorna Breen Health Care Provider Protection Act has been extended for five years, continuing funding through fiscal year 2030. The extension also mandates annual stigma-reduction campaigns and broadens grant eligibility to address administrative burdens. The AMA, a leader in physician well-being, supports this program and is actively working to reduce physician burnout by removing administrative obstacles and fostering the Joy in Medicine®.
PBM Reforms Aim to Lower Drug Costs
Targeted reforms to pharmacy benefit managers (PBMs) have been introduced to enhance transparency, curb abusive Medicare drug rebate practices, and strengthen enforcement against anticompetitive behavior. These provisions represent tangible progress toward lowering prescription drug costs and improving fairness in the drug supply chain for both patients and physicians. AMA President Bobby Mukkamala, MD, recently highlighted the unchecked power of the PBM industry and its potential harm to patients in a Leadership Viewpoints column.
Increased Funding for Maternal and Infant Health
The budget deal reauthorizes the PREEMIE Reauthorization Act, expanding federal research on preterm birth and improving outcomes for premature infants. It also reauthorizes the Preventing Maternal Deaths Act, increasing authorized funding to $100 million annually through 2030, expanding the scope of state maternal mortality review committees, and directing federal agencies to disseminate best practices. The AMA endorses both bills and remains committed to reversing the trend of rising maternal mortality rates.
In a statement released in January, David H. Aizuss, MD, chair of the AMA Board of Trustees, lauded the bipartisan effort. “The AMA commends congressional leaders for finding common ground,” he said. “As physicians, we know that the best results come from focused attention on what is best for patients. That’s what happened here.” Dr. Aizuss, an ophthalmologist in Calabasas, California, added, “To get to the finish line, individual negotiators didn’t get everything they wanted, perhaps, yet good policy emerged from the negotiations.” He emphasized that these proposals will have a real-world, beneficial impact on patients in their everyday encounters with physicians.
During uncertain times, the AMA remains steadfast in its commitment to advocating for physicians, allowing them to focus on what matters most: their patients. Hundreds of physicians will gather in Washington, D.C., February 23–25 for the AMA National Advocacy Conference, focusing on key issues such as reforming Medicare payment, fixing prior authorization processes, exploring the role of food as medicine, and protecting access to care in Medicaid. More information and registration details are available online, and interested parties can explore the AMA’s advocacy priorities in action.
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