Letter From the American College of Physicians to the U.S. Presidential Transition TeamFREE
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Note from Editor in Chief: Annals of Internal Medicine is publishing a letter from the American College of Physicians' leadership to the U.S. Presidential transition team. The letter identifies several issues that ACP believes are priorities to promote the health of Americans and offers to make the organization available to assist the administration in addressing these areas. The College routinely sends these letters to presidential transition teams, but this is the first time that one will be published in Annals of Internal Medicine. Annals is starting the tradition of publishing these letters so that the medical community is aware of the health policy issues that ACP is prioritizing in its advocacy efforts.
Dear President Trump:
On behalf of the American College of Physicians (ACP), congratulations on being re-elected as President of the United States. Under your leadership, actions were taken during your first term that supported the health and well-being of Americans. Your administration took important steps to reduce the cost of insulin and make prescription drugs more affordable. “Operation Warp Speed” accelerated the development of lifesaving COVID-19 vaccines and treatments.
Your administration also took significant steps to appropriately value primary care and reduce administrative burdens that helped support physicians' ability to spend more time delivering high-quality care to their patients. ACP is grateful for the progress that was made on these issues during your first term and welcomes the opportunity to work with you to continue improving the health and well-being of all Americans.
ACP is the largest medical specialty organization and the second-largest physician membership society in the United States. ACP members include 161,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge, clinical expertise, and compassion to the preventive, diagnostic, and therapeutic care of adults across the spectrum from health to complex illness.
As President, you have the opportunity and ability to improve the lives of countless people in this country through your policies. ACP supports evidence-based policy solutions to help maintain public health and wellness while also ensuring access to high-quality health care when and where a patient needs it. We stand ready to serve as a resource for your administration on these key issues. Specifically, we ask for your leadership and offer our support for efforts in four areas.
Improving Access to Internal Medicine Physicians and Others Providing Primary and Comprehensive Care
Research shows that greater availability of primary health care provided by internal medicine and other physicians is associated with decreased health expenditures, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality.
Additionally, state-level analyses show an association between investment in primary care and reductions in emergency department visits, total hospitalizations, and hospitalizations for ambulatory care–sensitive conditions. Despite these benefits, only between 6% and 8% (1) of health care dollars are spent on primary care (2).
ACP is grateful for the steps taken by the Centers for Medicare & Medicaid Services (CMS) under your prior leadership to strengthen primary care, and we look forward to working with Dr. Oz and your administration to continue this work. Internal medicine and other physicians who specialize in providing primary and comprehensive care are central to reducing the burden of chronic diseases and helping keep people healthy.
One barrier to patient access to primary care is a growing shortage of physicians specializing in primary care. It is estimated that by 2034 there will be a nationwide shortage of 17,800 to 48,000 primary care physicians. The challenge of seeing a physician when you need one (3) is already being felt throughout the country and no one is insulated from this problem. While there is no single solution to this problem, it starts with increasing federal graduate medical education programs' ability to train more primary care physicians; it also requires addressing the issues that often result in physicians leaving direct patient care, like insufficient payment and excessive administrative burdens.
Our ask is that you engage with ACP and the broader health care community to identify meaningful solutions that will increase patient access to primary care and improve health outcomes while reducing unnecessary spending.
Extending Health Insurance Tax Credits
One important way to build on your previous efforts to make health insurance more affordable is to extend, and make permanent, the health insurance premium tax credits for Health Insurance Marketplace coverage. These tax credits make health insurance more affordable for low-income Americans who do not qualify for Medicaid.
The health insurance premium tax credits are currently scheduled to expire at the end of 2025. The Congressional Budget Office projects that an estimated 3.4 million Americans will lose their health insurance coverage if these tax credits are not extended. A Kaiser Family Foundation (KFF) report (4) also estimates that roughly 19 million Americans will face double- or triple-digit increases in their premium payments; this includes estimates that premiums will increase by 90 percent in Florida, 115 percent in Texas, 102 percent in North Carolina, and 85 percent in Georgia, as residents of those states receive a greater share of premium tax credits than in other states. KFF also found that the tax credits cut consumers' costs by about 44 percent, saving the average enrollee $700 annually if they remain intact. We ask that you ensure that the health insurance premium tax credits are extended as part of a broader tax package next year.
Removing Unnecessary Red Tape to Improve Patient Care
Your administration took important steps to remove red tape and administrative burdens that needlessly delayed patient care and forced clinicians to spend time navigating insurance company bureaucracies instead of caring for their patients. Two of the most common types of administrative burden in health care are prior authorization and step therapy.
While addressing the rise of health care costs is very important, there is growing concern that these types of cost-utilization protocols do more harm than good. Not only do they increase the financial burden to physician practices, but they also contribute significantly to the current physician burnout epidemic. Medicare Advantage (MA) plans can require enrollees to receive prior authorization before a service will be covered, and nearly all MA enrollees (99 percent) are in plans that require prior authorization for some services in 2023. Further, in 2022, a survey of more than 500 doctors from group practices found that 89 percent believe that regulatory burdens increased in the past year, and 82 percent responded that the prior authorization process is very or extremely burdensome.
Additionally, KFF analysis of 2022 MA plan data showed that 46 million prior authorization requests were submitted to MA insurers on behalf of MA enrollees in 2022, up from 37 million in 2019 (5). Insurers fully or partially denied 3.4 million (7.4 percent) prior authorization requests, while more than 83 percent of denials that were appealed were partially or fully overturned. MA insurers' prior authorization requirements needlessly delay patient care and place a significant administrative burden on physicians and other clinicians.
ACP strongly supports policy changes to minimize and improve prior authorization and step therapy processes for patients and clinicians. Federal policies are needed to prevent discriminatory practices using artificial intelligence in prior authorization determinations, and to ensure that patients have access to appropriate treatments based on clinical decision making and medical necessity rather than arbitrary step therapy protocols. We stand ready to support efforts by your administration to address these issues and improve physicians' ability to provide seamless evidence-based care for their patients without unnecessary administrative delays.
Protecting Public Health
We are living in an age of unprecedented scientific and technological advancement in medicine, but unfortunately incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We applaud your previous administration's investment in “Operation Warp Speed” that accelerated the development of vaccines against COVID-19 and helped control the pandemic. We ask that you renew efforts to utilize the best-possible evidence to guide medical care and public health policies. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect all of us.
Conclusion
ACP stands ready to work with you to strengthen and improve the health and well-being of all Americans and support the physician and health care workforce caring for them. Please reach out to David Pugach, ACP Vice President for Governmental Affairs and Public Policy, at [email protected], should you have any questions or if we can be of assistance.
Sincerely,
Isaac O. Opole, MD, PhD, President, American College of Physicians, on behalf of the American College of Physicians
References
1.
Crowley R, Daniel H, Cooney TG, et al; Health and Public Policy Committee of the American College of Physicians. Envisioning a better U.S. health care system for all: coverage and cost of care. Ann Intern Med. 2020;172:S7-S32. [PMID: 31958805] doi: 10.7326/M19-2415
2.
Koller CF, Khullar D. Primary care spending rate - a lever for encouraging investment in primary care. N Engl J Med. 2017;377:1709-1711. [PMID: 29091564] doi: 10.1056/NEJMp1709538
3.
Opole IO. When the doctor will (not) see you now. I.M. Matters from ACP. Nov/Dec 2024. Accessed at https://immattersacp.org/archives/2024/11/when-the-doctor-will-not-see-you-now.htm on 30 December 2024.
4.
Ortaliza J, Cord A, McGough M, et al. Inflation Reduction Act health insurance subsidies: what is their impact and what would happen if they expire? Kaiser Family Foundation; 26 July 2024. Accessed at www.kff.org/affordable-care-act/issue-brief/inflation-reduction-act-health-insurance-subsidies-what-is-their-impact-and-what-would-happen-if-they-expire/ on 30 December 2024.
5.
Fuglesten Biniek J, Sroczynski N, Neuman T. Use of prior authorization in Medicare Advantage exceeded 46 million requests in 2022. Kaiser Family Foundation; 8 August 2024. Accessed at www.kff.org/medicare/issue-brief/use-of-prior-authorization-in-medicare-advantage-exceeded-46-million-requests-in-2022/ on 30 December 2024.
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Published In
Annals of Internal Medicine
Volume 178 • Number 2 • February 2025
Pages: 285 - 287
History
Published online: 14 January 2025
Published in issue: February 2025
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© 2025 American College of Physicians.
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Letter From the American College of Physicians to the U.S. Presidential Transition Team. Ann Intern Med.2025;178:285-287. [Epub 14 January 2025]. doi:10.7326/ANNALS-24-04125
Letter From the American College of Physicians to the U.S. Presidential Transition Team. Ann Intern Med.2025;178:285-287. [Epub 14 January 2025]. doi:10.7326/ANNALS-24-04125
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Unreservedly aghast
I read with disgust and disbelief the American College of Physicians’ (ACP) letter to the president’s transition team. ACP’s memory of Trump’s first term is what I expect from the far right but not from the ACP. My memory is that Trump has done nothing for patients nor primary care. Under his oppressive thumb and at his behest, the GOP tried 100 times to repeal the Affordable Care Act. He limited open enrollment, attempted to dismantle the healthcare.gov website (making enrollment so much more difficult), and tried to accelerate the insolvency of the Medicare trust fund. He was responsible for the reversal of Roe v Wade which has had significantly negative effects on bodily autonomy, and women’s and infant health in this country. He sought to eliminate the teen pregnancy prevention program and promoted abstinence until marriage as the alternative. This from a serial philanderer who has been successfully sued for sexual assault. And recall his gross incompetence of the handling of the pandemic that included a xenophobic portrayal of COVID as the “China virus,” refusal to endorse mask wearing, refusal to adhere to social distancing that led to multiple superspreader events and the death of Herman Cain, and the mind boggling press conferences in which he endorsed the use of bleach, and light therapy and insisted COVID would soon disappear. The US had far more deaths from COVID than any other developed country and we were a global embarrassment. And not to mention his stance on gun control which is the leading cause of death for children.
And now let’s fast forward to the first 30 days of this administration. His executive orders to withdraw the US from the WHO, to dismantle USAID, to halt transgender care for minors, to disavow people with nonbinary gender identity, to gut the CDC just to name a few. And to say nothing of his appointment of RFK Jr (an avowed anti-vaxxer with no medical or scientific background) for Secretary of HHS and his nomination of Dr Oz (a fringe snake oil salesman, in my opinion) for Director of CMS. This letter makes me embarrassed to be a member of the ACP. ACP must stand up for science, the sanctity of the provider-patient relationship, and defend the most vulnerable among us.