Insights^

On March 2, 2026, the Medicare Payment Advisory Commission (MedPAC) held the first day of its March meeting. The Commissioners held two sessions on the Medicare Advantage (MA) program, where they discussed the impacts of provider networks for beneficiaries as well as possible risk-adjustment policies. While the Commission is not planning to publish the work presented in these sessions in future reports to Congress, it was noted that the conversations would help guide future work by the Commission.

PROVIDER PARTICIPATION IN MA NETWORKS

MedPAC staff began the session by offering a comprehensive overview of MA networks and the beneficiary experience. Staff noted that provider participation in specific networks can change mid-year, which can greatly impact the beneficiary experience. Through 2023 claims and encounter data, MedPAC staff found that most clinicians participated in at least 1 MA network, with 75% of providers participating in 3 or more networks. Staff highlighted how mid-year provider network changes can be disruptive for enrollees as beneficiaries need to find new providers. MedPAC staff found that from February 2023 to June 2023, MA networks experienced a net increase in providers, with a 3% increase in primary care providers (PCPs) and a 1% increase in specialists. However, providers still left networks, with 6% of PCPs and 4% of specialists exiting by mid-year.

Commissioners were most interested in understanding the level of access beneficiaries have to providers, noting that provider participation in a network does not directly translate into beneficiaries having access in a reasonable amount of time. Some suggestions for ways to better measure access included understanding the types of care beneficiaries receive out of network, analyzing Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores for correlation rates, and offering structured interviews with beneficiaries, providers, and hospitals.

A few Commissioners suggested that future work could examine reasons why providers left a network, with one Commissioner pointing out that a large decrease in provider availability in a single network may be due to a larger system deciding not to renew a contract. One Commissioner who works in the space shared that, in his opinion, there are significant differences between data from 2023 and data from 2026 due to changes that reward clinical performance. The Commissioner explained that many MA plans are taking actions to steer beneficiaries towards high-performing but lower-cost care options, and removing higher-cost providers, which may have an impact on network robustness.

The Chair wrapped up the session by sharing that overall, the core value of the health system is being able to see a provider when care is needed, and conversations about MA provider networks can be difficult due to data completeness issues.

CONSIDERATIONS FOR IMPLEMENTING MA ENCOUNTER DATA IN RISK ADJUSTMENT

The MedPAC staff member provided an overview of how risk adjustment affects payments to MA plans and policy decisions that would need to be made in order to calibrate a risk adjustment system. There were 3 options presented. Under the first option, MA and Fee-For-Service (FFS) scores would be calculated from an MA-based risk model. Under the second option, MA and FFS risk scores would be calculated from separate MA-based and FFS-based risk models. Under the third option MA spending-based benchmarks would be calculated from existing MA data sources. Each option had different impacts on coding intensity and favorable selection, as well as partially or fully delinking MA payments from FFS data.

The Commissioners were very receptive to the presentation. No Commissioners expressed support for the first option, while options 2 and 3 were both of interest for future consideration. There was a desire from many Commissioners to create an external anchor for calculating payments, with a fear that if there is not an external source, it could be very easy for payments to increase drastically.

Commissioners had a few other considerations for a possible model, including clearly defining what constitutes an encounter, understanding the effects of different coding intensities, and separating benchmark and risk-adjustment policies. Commissioners shared the sentiment that moving towards a risk-adjustment model would improve plan data collection and reporting, which could be beneficial for other analyses.

Overall, the Commissioners were supportive of the options presented but wanted more pressure testing to better understand the possible implications for beneficiaries before a recommendation could be discussed.

On February 24, 2026, the House Ways & Means Health Subcommittee held a hearing on how to advance the next generation of the health care workforce. The discussion focused on expanding rural residency programs, rural workforce recruitment strategies, the use of foreign-trained physicians vs. developing a domestic health care workforce, and more.

OPENING STATEMENTS

• Rep. Adrian Smith (R-NE-3)
• Rep. Mike Thompson (D-CA-4)

WITNESSES

• Dr. Emily Hawes, Professor at UNC and Director, Sheps Graduate Medical Education Technical Assistance Center, Chapel Hill, NC – Testimony
• Mr. Jason Shenefield, CEO, Phelps Health – Testimony
• Dr. Thomas Mohr, D.O., Dean of Sam Houston State University College of Osteopathic Medicine – Testimony
• Dr. Jennifer Trilk, Ph.D., Director, Lifestyle Medicine, University of South Carolina School of Medicine, Greenville, Co-founder and Director of Lifestyle Medicine Education Curriculum – Testimony
• Dr. Andrew Racine, President, American Academy of Pediatrics – Testimony

MEMBER DISCUSSION

Rural Residency Programs

Rep. Adrian Smith (R-NE-3) asked Dr. Hawes to explain the process for establishing a rural residency program, especially for funding. Dr. Hawes shared that the biggest barrier is the initial start-up costs, and the Rural Residency Planning and Development (RRPD) Program is crucial for providing financial and technical assistance to help programs grow. Full Committee Chairman Jason Smith (R-MO-8) continued this line of questioning, asking how the funds are used. Mr. Shenfield shared that for his hospital, the funding can help with the administrative costs of the program and with creating clinical space for the residents to practice.

Rep. Carol Miller (R-WV-1) highlighted H.R. 6468, the Rural Residency Planning and Development Act of 2025, which would authorize rural residency planning and development programs. She also asked what other policy changes could be impactful for rural residency programs. Dr. Hawes answered that policies supporting telemedicine are greatly impactful, especially for psychiatric residency programs.

Rep. Brian Fitzpatrick (R-PA-1) asked how H.R. 3890, the Resident Physician Shortage Reduction Act of 2025, may be beneficial. Dr. Mohr explained that the legislation would provide greater clarity and certainty to hospitals looking to establish new rural residency programs.

Rep. Aaron Bean (R-FL-4) wanted the panel’s opinions on the possibility of shuffling the locations of residency spots every 10 years. Mr. Mohr shared that, in his view, there is a need to redistribute spots, but Dr. Hawes and Mr. Shenfield were concerned about the infrastructure required to support residency programs and the possible unintended consequences of the redistribution.

Rural Workforce Recruitment

Rep. Smith asked about challenges in recruiting physicians to rural health facilities. Mr. Shenfield stated that the need for physicians is greater in rural areas, but that there are fewer opportunities in rural communities, making it much harder to recruit physicians after they have completed their residency. Full Committee Chairman Smith asked how to improve the issue of medical students training in rural areas and then completing residency or practicing in urban areas. Dr. Mohr stated that solutions could include revisiting the graduate medical education (GME) caps, increasing training programs in rural areas, and updating medical education to promote rural practice. Dr. Hawes shared that residents often stay in the local community, so increasing rural residency spots is crucial.

Rep. Gregory Murphy (R-NC-3) highlighted that many rural communities are decreasing due to the lack of both healthcare and general infrastructure. Dr. Mohr agreed and stated that additional incentives are needed to attract residents to rural areas, and that improving infrastructure and opportunities in these communities could be helpful.

Rep. Miller requested that Dr. Mohr explain the role that Doctors of Osteopathic Medicine (DOs) can play in improving the rural workforce. Dr. Mohr shared that DOs are more likely to practice in rural and primary care settings, making them essential for meeting physician needs. Dr. Mohr highlighted the need for equity in licensing exams and residency spots for DOs.

Foreign Workforce

Rep. Linda Sanchez (D-CA-38) raised concerns that rural hospitals cannot afford the newly imposed H-1B visa fees, which would impact their workforce. Dr. Hawes agreed that the fees could have a negative impact. Dr. Racine argued that the fees would reduce the supply of doctors in rural areas, thereby affecting access to care.

Rep. Steube (R-FL-17) posed a variety of questions to the panel regarding supporting the foreign vs. domestic health care workforce. The panel expressed support for issuing visas to foreign-trained physicians but also agreed that there needs to be greater focus on training the domestic workforce. When asked by Rep. Steube what would help rural hospitals reduce the need for foreign-trained physicians, Mr. Shenfield said that the only answer was time to train the domestic workforce.

On February 26, 2026, the Senate Special Committee on Aging held a hearing to examine the Food and Drug Administration’s (FDA) review process for rare diseases. The witnesses all shared their frustration that the FDA has tools to allow for flexibility in drug approvals, but that these flexibilities are inconsistently applied across the various subagencies. In their view, this has led to confusion and a lack of transparency in the drug approval process. The committee discussed the current FDA landscape, manufacturing concerns, the impact of delays on patients, and possible policy actions. Possible policy actions discussed included improved clinical trial implementation, use of surrogate endpoints, funding for the Rare Disease Innovation Hub, and greater use of advisory committee meetings.

OPENING STATEMENT

• Chairman Rick Scott (R-FL)

WITNESS TESTIMONY

• Annie Kennedy, Chief Mission Officer, EveryLife Foundation for Rare Diseases – Testimony
• Dr. Jeremy Schmahmann, MD, Director, Massachusetts General Hospital Ataxia Center – Testimony
• Bradley Campbell, President and CEO, Amicus Therapeutics – Testimony
• Dr. Cara O’Neill, MD, FAAP, Chief Science Officer, Co-Founder, Cure Sanfilippo Foundation – Testimony

MEMBER DISCUSSION

Current FDA Landscape

Senators on both sides of the aisle expressed interest in how the FDA’s current FDA landscape impacts the review process for rare disease treatments. Sen. Ron Johnson (R-WI) was interested in the witness’s experiences interacting with the FDA. Dr. Schmahmann shared that he felt a lack of compassion from FDA personnel during meetings and that they did not engage in open dialogue about the science and patient experiences. Dr. O’Neill has had different experiences, sharing that her interactions with regulators have been kind, with them listening to patient experiences. However, Dr. O’Neill has not seen these experiences translate into regulatory action.

Sen. Angela Alsobrooks (D-MD) asked how changes in FDA personnel and guidance have affected trends in the rare disease drug approval process. Ms. Kennedy answered that she is increasingly concerned about application reversals and reports that the FDA has changed requests to sponsors at the last minute. Ms. Kennedy is most concerned about the lack of advisory committee meetings taking place now as compared to a few years ago, as these meetings allow for dialogue between FDA personnel, drug sponsors, and patients.

Sen. Andy Kim (D-NJ) was curious about the manufacturing process for rare-disease treatments. Mr. Campbell explained that many small and mid-sized companies rely on foreign manufacturing due to the time and costs required to build domestic manufacturing facilities. According to Mr. Campbell, it takes an average of 3-5 years to build a facility and an additional 1-2 years to pass FDA inspections before manufacturing can begin. So, while Mr. Campbell is supportive of onshoring drug manufacturing, he noted that the current regulatory environment makes it very difficult.

Impact on Patients

Chairman Rick Scott (R-FL) requested that witnesses share the effects of delayed treatment on patients as well as the ethical implications of stopping compassionate use for drugs. Dr. Schmahmann stated very clearly that delayed treatments lead to increased symptoms and decreased lifespan for patients while also reducing the quality of life for them and their families. Dr. Schmahmann was a strong supporter of compassionate use, sharing that, in his opinion, preventing compassionate use or suggesting trials that would force patients off helpful drugs is very unethical. Dr. O’Neill shared her frustration that the FDA is taking steps to reduce the use of animal models in drug testing due to ethical concerns, while not considering the ethical considerations of not allowing working treatments to be given to children with rare diseases.

Possible Policy Actions

Multiple Senators, including Sen. Dave McCormick (R-PA), Chairman Scott, and Ranking Member Gillibrand, were greatly interested in possible policy actions to better support the drug approval process. Mr. Campbell expressed support for the use of centralized Independent Review Boards (IRBs) and speeding up clinical trial implementation. Mr. Campbell also suggested providing more funding and attention to the Rare Disease Innovation Hub, which could allow for rare disease experts to be trained and deployed across the FDA. Ms. Kennedy felt that allowing greater use of surrogate endpoints and biomarkers would be extremely helpful in centering on patient experience and enabling the approval of treatments for medically complex diseases.

Ranking Member Gillibrand suggested greater use of advisory committee meetings as a path forward. Ms. Kennedy shared that advisory committee meetings are extremely impactful for allowing nuance in regulatory decisions, as they allow for outside experts to be included in decision-making. Dr. O’Neill continued that they allow for dialogue with patients and sponsors.

On February 25, 2026, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing to consider the nomination of Dr. Casey Means to be Surgeon General of the Public Health Service. The committee covered the topics of vaccines, nutrition, mental health, substance use, and women’s health. The next step in the confirmation process is for the Senate HELP Committee to hold an Executive Session to vote on the nomination. Assuming the Committee advances her nomination, it would next go to the Senate floor for a vote on confirmation.

OPENING STATEMENTS

• Chairman Bill Cassidy (R-LA)

WITNESS TESTIMONY

• Dr. Casey Means, Nominee to be US Surgeon General – Testimony

MEMBER DISCUSSION

Vaccines

The most prominent topic of conversation was Dr. Means’ views on vaccines. There was bipartisan questioning of whether Dr. Means views vaccines, such as those for the flu, measles, mumps and rubella (MMR), respiratory syncytial virus (RSV) and Hepatitis B (Hep B), as safe and effective for children. Dr. Means stated multiple times that she believes vaccines are key for public health. She also expressed support for the practice of shared clinical decision making and gaining informed consent from patients before administering vaccines. When pressed by Chairman Bill Cassidy (R-LA) about what additional steps pediatricians should take to obtain informed consent, Dr. Means did not have a concrete answer.

Nutrition

One of Dr. Means’ stated priorities is to improve nutrition and reduce consumption of ultra-processed foods. Many senators shared their support, including Ranking Member Bernie Sanders (I-VT), and Sens. Tommy Tuberville (R-AL), Roger Marshall (R-KS), and Ed Markey (D-MA). Sen. Marshall was curious about how Dr. Means expected to accomplish this goal, as many Americans do not have access to nutritious food options. Dr. Means acknowledged that if whole foods are not a sustainable choice, then many Americans will not change their behaviors. To help with this, Dr. Means highlighted the recent change in dietary guidelines encouraging procurement of food sources and her desire to encourage more federal research about food additives and pesticides.

Sen. Jon Husted (R-OH) shared concerns that changing views on pesticides could be detrimental for American farmers. Dr. Means responded that she greatly respects farmers but wants to change agricultural practices so that they are not as dependent on toxic chemicals.

Mental Health and Substance Use

Sens. Husted and Marshall were interested in understanding Dr. Means’ thoughts on the link that smartphones and social media have to adolescent mental health. Dr. Means shared that she is also concerned about the effects of technology on mental health and is committed to working with various public and private sectors to protect children from the harms of smartphones and social media.

Sen. Susan Collins (R-ME) raised concerns about Dr. Means past statements promoting illicit drug use, given the rise in substance use disorders. Dr. Means reassured the senator that she would not make similar statements while in office, as the science is still emerging about the use of various drugs to treat health conditions.

Women’s Health

Chairman Cassidy and Sen. Patty Murray (D-WA) asked about the use of oral contraception, such as Mifepristone pills, and both hormonal and non-hormonal birth control options. Sen. Murray questioned whether Dr. Means supports their approval by the Food and Drug Administration (FDA) due to past comments about their “horrifying health risks for women.” Dr. Means expressed the view that these medications should only be prescribed after an in-depth conversation with a physician and after gaining informed consent about possible risks and side effects. Chairman Cassidy asked if these medications should only be prescribed after an in-person doctor’s visit to which Dr. Means stated that such a requirement is outside of the purview of the Surgeon General’s office.

Sens. Jim Banks (R-IN), Tim Kaine (D-VA), and John Hickenlooper (D-CO) were curious about Dr. Means’ approach to In-Vitro Fertilization (IVF). Dr. Means shared that she is supportive of access to IVF treatments but wants to emphasize the positive effects of lifestyle changes in supporting increased fertility, especially for Polycystic Ovary Syndrome (PCOS).

Vision for the Role

Dr. Means shared that her overall vision as US Surgeon General would be to improve health outcomes through better nutrition and the consumption of whole food and encouraging the healthcare system to focus on the root causes of disease, rather than addressing symptoms and providing sick care. Dr. Means also plans to champion research on environmental exposures that cause disease. Dr. Means believes that her interdisciplinary background allows her to approach the position in a unique way. She hopes to be a messenger and champion solutions to reduce healthcare spending in the United States.