June Government Affairs — What You Need to Know
by ACOI
May 30, 2025
ACOI Endorses Legislation to Improve Transparency of COMLEX Acceptance
On May 12, ACOI issued its support of the Fair Access in Residency (FAIR) Act (H.R. 2314) in a letter sent to the sponsors of the bill. The FAIR Act establishes two reporting requirements for Medicare-funded GME programs:
- An annual report detailing the number of DO and MD applicants and accepted residents.
- An affirmation that DO applications and COMLEX-USA exam scores are accepted for consideration.
Programs that fail to comply would face a 2 percent annual reduction in Indirect Medical Education payments.
In its letter, ACOI described the bill as a “reasonable approach to ensuring osteopathic medical students can fairly compete for federally supported residency training positions.” In response to stakeholders who counter the FAIR Act is unnecessary because progress is being made among ACGME-accredited programs to accept the COMLEX exam, ACOI stated in its letter that introduction of the legislation “serves as a catalyst to support awareness and to encourage residency programs to voluntarily utilize the COMLEX exam as equivalent to USMLE.”
ACOI has also joined a coalition of organizations, led by the American Association of Colleges of Osteopathic Medicine, in support of the bill.
House Passes Sweeping Tax and Spending Bill
On May 21, the House came together to pass its version of a sweeping tax and spending bill that is now in the Senate’s court.
The bill is an important step forward in addressing Medicare physician payment by incorporating a partial inflationary update for 2026 and beyond.
Specifically, the bill:
- Provides physicians, under the Medicare fee schedule, an inflationary update in 2026 that is 75 percent of the Medicare Economic Index (MEI)—a measure of practice cost inflation. Based on current projections, the update would be roughly 2.25% in 2026.
Without a change in policy, the 2026 Medicare physician fee schedule conversion factor update will be a 0.75 percent increase for Qualified Advanced Alternative Payment Model (APM) participants and a 0.25 percent increase for all other clinicians.
- Beginning in 2027 and onward, the physician payment update would be based on 10 percent of MEI.
Read ACOI’s all-member announcement on the proposed payment policy revisions here.
Many other provisions are concerning. Notably, the bill includes changes to Medicaid and the Affordable Care Act (ACA) exchanges that could result in loss of health care coverage for millions of individuals.
Among the changes the bill would make include:
- freezing state provider taxes that could force states to make major changes to their Medicaid programs, which could include cutting some combination of benefits, eligibility, and payment rates for health care providers;
- modifying when states can provide retroactive Medicaid and CHIP coverage from three months to one month preceding the month in which an eligible patient submits their application for assistance under the program; and
- creating additional administrative barriers for ACA enrollment including shorting the open enrollment period to 45 days, rather than the current 75 days.
In the days and weeks ahead, ACOI will advocate for essential changes, including addressing Medicaid and ACA provisions that create barriers to health care coverage and services or result in reductions in Medicaid.
House Advances Student Loan Policy Changes
Included in the tax and spending bill passed by the House on May 21 are provisions that would change the student loan infrastructure that could negatively impact the next generation of physicians and the nation's ability to meet future physician workforce demands.
Provisions include:
- elimination of Federal Direct Graduate (GRAD) PLUS loans for new borrowers starting in the 2026-2027 academic year and for existing borrowers starting in 2029-2030;
- a cap on the amount of Federal Direct Unsubsidized loans a student can borrow for professional school to $150,000;
- removal of time spent in residency as a public service job, making residents ineligible for the Public Service Loan Forgiveness (PSLF) program;
- elimination of the current income driven repayment (IDR) plan, which would be replaced by a new Repayment Assistance Plan which would require a borrower to remain in repayment for 30 years (instead of 25 years), before they could receive forgiveness, and repayment amounts would be based on the borrower’s adjusted gross income maxing out at 10 percent for individuals who make more than 100,000 per year.
ACOI has joined two letters to congressional offices opposing these changes. One of the letters was led by the American Osteopathic Association and the other letter by the American Association of Colleges of Osteopathic Medicine and the Association of American Medical Colleges.
Seniors’ Act Reintroduced with Strong Bipartisan Support
The Improving Seniors’ Timely Access to Care Act (H.R. 3514 / S. 1816) was officially reintroduced on May 20 with strong, bipartisan support of 47 senators and 73 representatives. The legislation, supported by ACOI, would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization Processes (e-PA) rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024.
Notably, the bill, which applies to Medicare Advantage (MA) plans, would increase transparency around MA prior authorization requirements and their use. Under current regulations, plans must report contract-level metrics like the percentage of standard prior authorization requests that were approved and denied. Those metrics are aggregated across all items and services. The legislation would require more granular reporting by categories of items/services, which will provide greater transparency and more meaningful information to CMS, providers and patients.
ACOI members are encouraged to contact their members of Congress and ask them to cosponsor the Seniors’ Act through the ACOI Action Center.
Senate Companion Legislation Introduced to Stop Physician Pay Cut
Recently, Senator Roger Marshall, MD (R-KS) introduced the Medicare Patient Access and Practice Stabilization Act (S. 1640), which, if passed, would reverse the 2.83 percent cut to Medicare physician payment that took effect on January 1, 2025 and provide a 2 percent positive adjustment, which is an increase equivalent to roughly half of the Medicare Economic Index (MEI) for 2025.
S. 1640 is companion legislation to H.R. 879 which was introduced earlier this year by Representatives Greg Murphy, MD (R-NC) and Jimmy Panetta (D-CA).