Insights

On September 15, the House Energy and Commerce Health Subcommittee held a hearing to examine legislative proposals to reform Medicare provider payment and bolster health care cybersecurity. Members expressed urgency on physician payment reform and signaled interest in moving the legislation discussed before the end of Congress. Democratic members also took the opportunity to highlight their disagreements with H.R. 1, otherwise known as the One Big Beautiful Bill Act. The member discussion section below is organized by bill. Bills for which there was not significant discussion include only the bill description.

OPENING STATEMENT

• Health Subcommittee Chairman Morgan Griffith (R-VA-9)
• Health Subcommittee Acting Ranking Member Lizzie Fletcher (D-TX-7)
• Full Committee Chairman Brett Guthrie (R-KY-2)
• Full Committee Ranking Member Frank Pallone (D-NJ-6)

WITNESS TESTIMONY

• Greg Garcia, Executive Director for Cybersecurity, Healthcare and Public Health Sector Coordinating Council (HSCC) – Testimony
• Anthony Pudlo, PharmD, MBA, MS, CEO, Tennessee Pharmacists Association (TPA) – Testimony
• Murad Alam, MD, MSCI, MBA, FAAD, President, American Academy of Dermatology Association (AADA) – Testimony
• Rebecca Andrews, MS, MD, MACP, Immediate Past Chair, Board of Regents (2026-2027), American College of Physicians (ACP) – Testimony
• Eilean Attwood, MD, MPH, Immediate Past Chair of the Committee on Health Economics and Coding, American College of Obstetricians and Gynecologists (ACOG) – Testimony
• Gabi Conecker, MPH, Co-Founder and Executive Director, Decoding Developmental Epilepsies – Testimony

MEMBER DISCUSSION

H.R. 9693, Patients First Act

This bill would provide a permanent annual inflation update to Medicare physician payments tied to the Medicare Economic Index (MEI) minus 1, raise the budget neutrality threshold, establish a 5-year hybrid payment pilot for independent primary care practices, and reform the Merit-based Incentive Payment System (MIPS) quality reporting program.

Full Committee Chairman Brett Guthrie (R-KY-2) and Reps. Troy Carter (D-LA-2), Greg Landsman (D-OH-1) and John Joyce (R-PA-13) asked Drs. Alam and Andrews how the bill’s reforms would address challenges physicians face under the system created by the Medicare Access and CHIP Reauthorization Act (MACRA). Dr. Alam identified 3 compounding problems: the lack of an inflation update, the inequality inherent in budget neutrality requirements, and administrative burdens driving health care consolidation. Dr. Andrews highlighted the 5-year hybrid pilot as allowing primary care practices to be compensated for care coordination work that fee-for-service does not cover.

Health Subcommittee Vice Chair Diana Harshbarger (R-TN-1) asked Dr. Andrews whether Medicare’s payment structure is contributing to the primary care workforce shortage. She said it is and pointed to the lack of an inflation adjustment since 2001 as a contributing factor. Rep. Erin Houchin (R-IN-9) followed up, asking what the reforms would mean for rural independent practices. Dr. Andrews called the bill “the first bit of hope I’ve had in a long time” and stated that payment stabilization would allow independent practices to maintain a viable business model.

Reps. Kim Schrier (D-WA-8) and Troy Balderson (R-OH-12) asked Dr. Alam about MIPS measures for dermatologists. He explained that current measures do not reflect actual quality, are rarely developed with specialist input, and cost physicians roughly 53 hours and $13,000 a year without improving care. He recommended building quality measurements across all specialties from existing clinical data registries.

Rep. Raul Ruiz (D-CA-25) pressed both Dr. Alam and Andrews on whether they would prefer full MEI reimbursement. Both said yes but called the Patients First Act a great first step at a time when change is needed.

H.R. 3164, Ensuring Community Access to Pharmacist Services (ECAPS) Act

This bill would create Medicare Part B coverage for pharmacist-provided testing and treatment of common respiratory illnesses, consistent with state scope-of-practice laws. Health Subcommittee Chairman Moran Griffith (R-VA-9) and Rep. Troy Carter asked about the impact of allowing pharmacists to test and treat certain illnesses. Dr. Pudlo explained that pharmacists help triage patients into the health care system when other providers are unavailable and that the bill would allow pharmacists to provide services in Medicare that they already provide under other coverage.

Full Committee Chairman Guthrie and Health Subcommittee Vice Chair Harshbarger asked Dr. Pudlo how this care could reduce costs. He explained that pharmacists prevent patients from going to more expensive settings like emergency departments, which reduces the costs Medicare must cover.

Rep. Nanette Barragan (D-CA-44) questioned how community pharmacists can help address vaccination disparities among Black and Latino seniors on Medicare. Dr. Pudlo stated that access alone does not reduce disparities, but trust built over years of patient relationships creates conditions for preventive conversations and education.

H.R. 1254, Rural Obstetrics Readiness Act

This legislation would create an obstetric readiness training program for rural facilities without dedicated labor and delivery units, fund federal equipment grants, and establish a pilot teleconsultation program connecting OB-GYNs with clinicians in rural facilities facing obstetrics emergencies.

Health Subcommittee Chairman Guthrie asked Dr. Attwood how to build the maternal health workforce pipeline in rural communities beyond payment reform. She described the benefits of cross-specialty obstetric emergency training programs that this bill would formalize and scale nationally.

Health Subcommittee Acting Ranking Member Lizzie Fletcher (D-TX-7) questioned how maternity ward closures impact patient access to care and maternal mortality outcomes. Dr. Attwood said closures mean longer distances, delayed care, and compounding safety risks, noting that more than 50 maternity wards have closed or announced closure plans since passage of the reconciliation bill. Rep. Mike Kelly (R-PA-16) followed up asking how training and equipment can bridge the gap caused by closures. Dr. Attwood explained that working directly with trainees is the first step, but it is equally important to ensure they have the tools they need to keep the mom and baby safe.

Rep. Cliff Bentz (R-OR-2) pressed Dr. Attwood on liability as a barrier for clinicians managing obstetric emergencies without dedicated OB staff and for teleconsultation. She acknowledged the financial pressures and stated that stabilizing Medicare physician payment rates, which inform Medicaid rates covering about 40% of births nationwide, would be one necessary piece. Dr. Attwood further explained that teleconsultation models already exist in other specialties, which she argued demonstrates they can function effectively with the right relationships and training programs in place.

H.R. 6130, Alzheimer’s Screening and Prevention (ASAP) Act

This bill would create a Medicare coverage pathway for FDA-approved blood-based biomarker tests for early detection of Alzheimer’s disease and related dementias.

Health Subcommittee Chairman Griffith and Rep. Balderson asked how the bill would improve care and how it would provide cost savings. Dr. Andrews stressed the importance of early diagnosis in both improving care and reducing costs.

Rep. Paul Tonko (D-NY-20) asked Dr. Andrews about the challenges physicians face in diagnosing and managing Alzheimer’s and whether blood-based biomarker tests would help in earlier diagnoses. She explained that these tests produce probabilities rather than definitive answers, and that walking a patient’s family through those results takes time currently not covered by fee-for-service. She noted the hybrid payment pilot in the Patients First Act would help address that gap.

H.R. XXXX, Healthcare Cybersecurity and Resiliency Act of 2026

This legislation, which is a discussion draft, would expand cybersecurity resources across the health care system and require providers and plans to disclose the number of individuals affected when notifying them of a data breach.

Full Committee Chairman Guthrie and Rep. Balderson asked Mr. Garcia how to enhance cybersecurity capacity without creating duplication or excess burden. He explained that more regulation of the health care sector itself is not the answer, but that the focus needs to be on third-party technology vendors that supply hospitals and systems and are not held to the same standards. He added that funding for workforce development and technology, combined with mutual assistance across rural communities, would be most impactful.

H.R. 9908, Rural Hospital Cybersecurity Enhancement Act

This bill would direct the Department of Health Human Services (HHS) to develop a comprehensive rural hospital cybersecurity workforce strategy and expand training resources for rural providers.

Rep. Houchin asked how the bill would improve coordination between HHS, the Department of Homeland Security (DHS), and the health care sector and what gaps in the current federal response it would address. Mr. Garcia pointed to ongoing private-sector work in mutual assistance and partnership.

 H.R. 1521, Dental Optometric Care (DOC) Access Act

This legislation would prohibit private insurance companies from setting rates for certain dental and vision services for which the plan does not pay a substantial amount.

Rep. Buddy Carter (R-GA-1) asked about the consequences of independent practice consolidation on patient care, using vision management as an example. Dr. Alam explained that rural practices close first, resulting in longer wait times and advanced disease at diagnosis.

H.R. 8163, Provider Reimbursement Stability Act

This legislation would update the underlying structure of the Physician Fee Schedule to improve predictability for physician payments.

H.R. 1189, National Plan for Epilepsy Act

This bill would create a national coordinated plan for epilepsy research, care, and data collection across federal agencies.

H.R. 1616, Promoting Access to Diabetic Shoes Act

This legislation would remove administrative barriers for seniors accessing therapeutic diabetic shoes when their care is managed by a nurse practitioner or physician assistant.

H.R. 5737, Radiology Outpatient Ordering Transmission (ROOT) Act

This bill would fix the paused Appropriate Use Criteria program to support appropriate imaging utilization at the point of care.

H.R. 8622, Medicare Physician Data-Driven Performance System Act

This legislation would create a new outcomes-based Medicare physician payment model focused on value over volume.

H.R. 7863, Promoting Fairness for Medicare Providers Act

This bill would align Medicare reimbursement for a narrow group of procedures involving high-cost medical supplies, paying physician offices at 90% of what Medicare would pay an ambulatory surgical center for the same service.

H.R. 4331, Access to Claims Data Act

This legislation would require HHS to establish a process allowing qualified clinical data registries to access Medicare claims data to support research and quality improvement.

H.R. 7905, Diabetes Foot Health Access and Modernization Act

This bill would recognize podiatric physicians under Medicaid and clarify Medicare documentation requirements for therapeutic shoes for people with diabetes.

H.R. 6214, Kidney Care Access Protection Act

This legislation would protect Medicare beneficiaries with kidney disease from losing coverage for dialysis and other treatments under employer-sponsored health plans.

H.R. 8319, KIDNEY Remote Monitoring Act

This bill would expand Medicare coverage of remote monitoring services for patients with kidney disease to improve year-round access to care.

On September 14, 2026, the House Judiciary Subcommittee on the Administrative State, Regulatory Reform, and Antitrust held a field hearing to examine fraud and competition within the health care system. The hearing focused on combating alleged fraud in public health programs, addressing concerns about hospital consolidation, and dealing with health care workforce shortages. Only Republican members attended, so the hearing focused on the failures of Democratic initiatives such as the Affordable Care Act (ACA) and Medicaid expansion.

OPENING STATEMENTS

• Subcommittee Chair Scott Fitzgerald (R-WI-5)

WITNESS TESTIMONY

• Dr. Brian Miller, Associate Professor of Medicine, Johns Hopkins University; Vice Chairman, North Carolina State Health Plan – Testimony
• Dr. Brian Blase, PhD, President, Paragon Health Institute – Testimony
• Katherine Martin, Vice President of Health Affairs, University of North Carolina System – Testimony

MEMBER DISCUSSION

Health Care Fraud

Republicans who attended the hearing focused much of their discussion on concerns about alleged fraud in public health care programs. Representative Harriet Hageman (R-WY-At Large) highlighted recent Department of Justice enforcement actions against alleged health care fraud in states like California and Minnesota. Rep. Hageman asked the witnesses about the scope of fraud in the health care system. Dr. Blase responded that it is significant, and that states are incentivized to overlook fraud in public programs because they must return recovered funds to the federal government. When asked how Congress could shift toward more preventive anti-fraud measures, Dr. Blase recommended establishing a minimum premium payment for ACA plans and auditing federal Medicaid payments to states.

Other members raised questions and concerns about alleged fraudulent ACA enrollment and the witness’s views on policies related to expanded federal reimbursement tied to Medicaid expansion. For example, Subcommittee Chair Scott Fitzgerald (R-WI-5) asked Dr. Miller about his view on reported fraud within the ACA market. Dr. Miller said stronger eligibility verification and routine oversight of providers and brokers are needed to combat fraud in both ACA and Medicaid markets. Members such as Representative Russell Fry (R-SC-7) criticized the higher federal matching rate paid for the Medicaid expansion population as being unfair to the traditional Medicaid population. Dr. Blase agreed and said Congress should eliminate that higher rate. In response to a question from Rep. Hageman about recommendations that could be made through the congressional reconciliation process, Dr. Blase said Congress could reduce the higher reimbursement rate for the expansion population and make changes to the ACA marketplace to combat fraud.

Hospital Consolidation

Members and witnesses broadly agreed that whatever benefits consolidation may offer are generally outweighed in the health care sector by negative impacts on affordability, quality, and access. Members such as Representative Bob Onder (R-MO-3) focused their concerns on hospital mergers. Rep. Onder identified several policies he believes drive consolidation, including the expansion of the 340B drug program, hospitals being reimbursed more than other providers for the same services, hospitals being reimbursed at a higher rate than physicians, restrictions on physician-owned hospitals, certificate of need laws, the nonprofit exemption under the Stark law, and the ACA medical loss ratio. Other members also expressed opposition to certificate of need laws, restrictions on physician-owned hospitals, and the ACA medical loss ratio. Representative Chuck Edwards (R-NC-11) asked what tools exist to hold hospital systems accountable, short of removing them from Medicare. Dr. Miller agreed that the Centers for Medicare and Medicaid Services should have more enforcement tools but emphasized that the priority should be allowing more competition.

Health Care Workforce Shortages

Rep. Mark Harris (R-NC) raised concerns about nursing shortages, saying that North Carolina currently faces one of the largest nursing shortages in the country. He also highlighted the state’s $40 million allocation to address this shortage. Rep. Fitzgerald asked the witnesses what challenges providers face in filling residency slots, and Ms. Martin explained that graduate medical education slots increasingly flow to large, consolidated hospital systems rather than to smaller and rural providers. Rep. Edwards added that physician distribution must be addressed so that rural districts are not left behind as systems consolidate.

Other Topics

• Rep. Hageman brought up the Rural Health Transformation Program (RHTP) and asked whether the witnesses advise states on it. Dr. Blase confirmed that Paragon Health Institute has a state reform initiative and that Paragon would be happy to advise states on the RHTP.
• Members, such as Rep. Tim Moore (R-NC-14), raised concerns about pharmacy benefit manager concentration and its effect on prescription drug prices. Dr. Blase expressed support for increased transparency, arguing that the PBM sector has limited transparency.