The Louisiana State Medical Society was formed in 1878 with the sole purpose of advancing "healthcare in the state of Louisiana. Today our mission is to be the trusted advocate for patients and physicians in the State of Louisiana. Learn more about the history of LSMS here: https://lsms.org/page/History.
Established 1878
JULY 2025
WHAT’S INSIDE
2 A MESSAGE FROM YOUR COL LEADERS ABOUT THE LSMS COUNCIL ON LEGISLATION 3 MEET YOUR LSMS COUNCIL ON LEGISLATION 8 PHYSICIAN COALITION OF LOUISIANA 9 2025 LEGISLATIVE RECEPTION 10 2025 WHITE COAT WEDNESDAY 12 THE FOLLOWING ARE LETTERS RELATED TO ISSUES FROM PRIOR SESSION 13 MEDICAID CUTS LETTERS 22 FREEMAN ELECTED AS VICE CHAIR OF THE AMA SOUTHEASTERN DELEGATION AMERICAN SOCIETY OF MEDICAL ASSOCIATION COUNSEL WE WILL MISS YOU TERRI!
2025 Louisiana Legislative Session Page 4
MEET YOUR LSMS COUNCIL ON LEGISLATION
MESSAGE FROM YOUR COL LEADERS ABOUT THE LSMS
COUNCIL ON LEGISLATION
The Council on Legislation is composed of one member from each of the LSMS’ ten (10) medical districts, one member from each LSMS Section as delineated in our bylaws. Additionally, a specialty medical society who sends a physician representative to our annual meeting will receive one seat on the council. Lastly, the LAMPAC Chair serves as an ex- officio member. Prior to each session the COL meets to identify issues of concern for physicians. As part of this meeting, members determine a path forward on how to solve problems caused by these varying issues, which may include seeking legislation. On one of the first Saturdays of each session, members spend the morning reviewing legislation and determining a position for filed instruments. This is the primary tracking document that staff will use throughout the legislative session. Each week during session, Zoom meetings are held to update the COL and seek information and guidance on any changes made to particular bills. During these weekly calls, amendments are discussed, and positions can be changed. It is a huge time commitment from these physicians. Please give them your thanks if you happen to know them!
REPRESENTING
MEMBERS
Chair
Matthew Giglia, MD
MATT GIGLIA, MD COL CHAIR
CLAY RUNFALO, MD COL VICE CHAIR
Vice-Chair
Clayton Runfalo, MD
District 1
Maurice Sholas, MD
District 2
Luis Arencibia, MD
The 2025 Fiscal Session of the Louisiana Legislature is done! After thoughts and conversations, we believe now is the time to make sure all physicians understand that there is trouble ahead for our patients and us. So, we want to reflect on a few details that were made crystal clear this session. 1. Soundbites and social media posts reign supreme. We’re clearly still living in the world of “if it’s on the internet, it must be true,” only we’re now including social media. We continue to expend energy to overcome misinterpretation of facts and information put out into the world through the use of one-line posts and ten-second videos. The upside is that while legislators clearly need social media to push their messaging, they do seem to recognize the dangers of believing everything they see and hear. However, that distrust has not transferred itself to the general public, many of whom live in echo chambers devoted to their own interpretation of fact. 2. Our continued push for physician involvement cannot stop! While we don’t want to sound like we’re fussing, we are fussing!!! As physicians, we all must take heed! Science and medicine are under attack! Our staff has been screaming this from the rooftops for several years now. We need to hear them. We were witnesses to what they have been telling us. We can’t continue to rely solely on them to deliver our message. While we sincerely thank the COL and members who are involved and do take action, your patients need more of us to step up! 3. Your personal stories and answers are impactful. Those physicians who took the time to testify at the Capitol made a difference! Our appreciation for your time and expertise is huge. To name some of those we remember appearing: Drs. Bridges, Bocchini, Fletcher, Prasad, Trawick and Tynes. Please forgive us if we missed anyone and know we welcome your willingness to join the conversation. 4. We need you to commit to membership and support. Please make sure you are up to date on your membership – to include verifying we have accurate information enabling us to communicate with you. Please contribute to our PAC. Please recruit your peers to the fold. Please ask for staff to share knowledge by hosting a meeting of your peers and allowing them to give you a legislative update. (Bonus – CME is available!) Please pay attention to what you’re hearing locally and share that information with us. We end by saying Thank You to the LSMS staff. This session was frenetic in its pace and in the number of issues discussed. Our staff worked diligently to protect us and our patients. Take the time when you see them to express your appreciation to them, too.
District 3
Christopher Rodrigue, MD
District 4
Deborah Fletcher, MD
District 5
Vince Forte, MD
District 6
Cheryl Hickey, MD
District 7
Steven Hale, MD
District 8
Christina Lord, MD
District 9
Kevin Duplechain, MD
District 10
Joshua Sleeper, MD
Private Practice Section Matthew Bernard, MD Employed Physician Section Clay Runfalo, MD Young Physician Section Ken Ehrhardt, MD Resident / Fellow Section Omar Leonards, MD Medical Student Section Olivia White LAMPAC Chair (ex-officio) Susan Bankston, MD Addiction Medicine Smita Prasad, MD Cardiology Frederico De Puy, MD Emergency Medicine Daniel Sessions, MD Family Medicine Richard Bridges, MD Internal Medicine Celeste Newby, MD OB-GYN Nicole Freehill, MD Orthopaedics Samer Shamieh, MD Psychiatry Robert Dahmes, MD Radiology Neel Gupta, MD
PAGE 2
PAGE 3
2025 LOUISIANA LEGISLATIVE SESSION The 2025 Louisiana Legislative Session adjourned Sine Die on June 12. While this was a fiscal session pursuant to the Louisiana constitution, you wouldn’t have known that from the filed legislation. Take a look at the table below to get a “Maria’s Count” (– which means it sure isn’t perfect) of what those numbers looked like. To clarify for you, the bills counted in the “Fiscal” line only include those that could not have been debated in a Regular Session year. You have Appropriations, Capital Outlay and other measures that are filed in a Regular Session which are not in that number and do not count against the author’s 5 bill maximum. 2025 FISCAL SESSION STATS Measures levying or authorizing a new state tax, increasing an existing state tax, or legislating with regard to state tax exemptions, exclusions, deductions, or credits may be introduced HOUSE SENATE Bills (720 max general subject) 696 248 Concurrent Resolutions 83 70 Resolutions 383 207 Totals 1,162 525 House and Senate Combined 1,687 Fiscal (of 944 bills) 125 13% TRACKED BY LSMS All instruments 131 8% Bills only 124 13%
LSMS REQUESTED LEGISLATION
INSTRUMENT DESCRIPTION
POSITION RESULT
Gives healthcare licensing boards the ability to enforce requirements that providers display evidence of appropriate credentials in advertising. Urges Congress to take action on pharmacy benefit managers and their impact on the citizens of Louisiana.
HB 423 by Rep. Jeremy LaCombe
Act 362. Effective Aug. 1, 2025.
Support
Enrolled. Sent to Secretary of State. Enrolled. Sent to Secretary of State. Enrolled. Sent to Secretary of State. Enrolled. Sent to Secretary of State.
HCR 73 by Rep. Chris Turner
Support
HR 313 by Rep. Jeremy LaCombe
Urges Congress to take action on the use of artificial intelligence in health care.
Support
SCR 13 by Sen. Thomas Pressly
Urges Congress to take action regarding the ongoing use of prior authorization processes.
Support
Urges Congress to take action relative to the corporate practice of medicince and how it impacts the citizens of Louisiana.
SCR 27 by Sen. Patrick McMath
Support
SCOPE OF PRACTICE
INSTRUMENT DESCRIPTION
POSITION RESULT
As written, the bill made significant changes opening the practive of physical therapy. Rep. Stagni approached us for amendments and accepted all of them. With the amendments, LSMS moved from Oppose to Monitor.
Oppose
HB 159 by Rep. Joe Stagni
Act 65. Effective Aug. 1, 2025.
Monitor
HB 272 died as Rep. Bamburg refused to request a hearing to advance the bill.
HB 272 by Rep. Dennis Bamburg
Significantly rewrote the Athletic Trainers' Practice Act.
Oppose
As written, the bill completely removed any physician from oversight of audiologists. It further expanded the scope of an adiologist. Amendments requested by LSMS were added to the bill limiting it allowing for ear wax removal. LSMS moved from Oppose to Monitor.
Oppose
HB 442 by Rep. Chance Henry
Act 363. Effective Aug. 1, 2025.
Monitor
Act 464. In effect as of June 20, 2025.
SB 19 by Sen. Mike Fesi
Establishes a state standing order that allows pharmacists to dispense ivermectin.
Oppose
PAGE 4
PAGE 5
EXECUTIVE BRANCH IMPACTS
LEGAL ISSUES RELATED TO AUTO INSURANCE
INSTRUMENT DESCRIPTION
POSITION RESULT
INSTRUMENT DESCRIPTION
POSITION RESULT
"The Appropriations Bill includes two specific items that are positive for physicians: 1- Increase the Medicaid professional service fee schedule to 85% of Medicare.
"Modifies comparitive fault in statute as it relates to a plaintiff's fault in the injury to say: - If the plaintiff is 51% at fault or greater, no recovery is allowed. - If the plaintiff is less than 51% at fault, the damages are reduced by that percentage." Restores a plaintiff’s obligation to prove all elements of a claim for damages, including causation - effectively overruling the Housely Presumption. Increases transparency in the calculation of medical damages in civil litigation by allowing courts to consider both the amounts billed and actually paid for medical care. A section that established a 300% of medicare rate as reasonable for medical expenses was removed on the Senate floor at physicians' request. This moved LSMS from Oppose to Monitor.
HB 1 by Rep. Jack McFarland
Act 1. Effective July 1, 2025
HB 431 by Rep. Emily Chenevert
Act 15. Effective January 1, 2026
Support
Monitor
2- Includes funding for a Physician Loan Repayment Program in Primary Care."
This is a great bill! Focuses on coordination of benefits, administrative simplification and prohibits MCOs from downcoding unless LDH promulgates rules. Establishes a Medicaid Trust fund for Additction Recovery to be used to enhance payments for addiction providers. HB 690 was a substitute for HB 377 focused on Emergency Use Authorized vaccines and medical equipment. LSMS was heavily opposed to HB 377 which was deferred in its originating committee. Rep. Owen came back with a request to have LDH promulgate rules regarding information for patients on EUA vaccines and equipment.
Active 206. Effective August 1, 2025.
HB 565 by Rep. Annie Spell
HB 450 by Rep. Michael Melerine
Act 18. Effective May 28, 2025
Support
Monitor
Act 392. In effect as of June 20, 2025.
HB 658 by Rep. Chris Turner
Oppose
Support
SB 231 by Sen. Mike Reese
Act 466. Effective January 1, 2026.
Monitor
Act 396. In effect as of June 20, 2025.
HB 690 by Rep. Chuck Owen
Monitor
CAUSES OF ACTION, CRIMES AND MORE…
Failed in House Health and Welfare.
SB 2 by Sen. Mike Fesi
Sought to remove fluoride from public water systems.
Oppose
INSTRUMENT DESCRIPTION
POSITION RESULT
As filed, the bill allowed for a civil suit - outside of the Medical Malpractice Act - against any person who performs, causes or substantially facilitates an abortion by administering, prescribing, dispensing, distributing, selling or coordinating the sale of an abortion-inducing drug a person in Louisiana. Sen. Beth Mizell successfully amended the bill in Senate Jud A to say a suit cannot be brought against "a healthcare provider licensed to practice medicine in this state," moving LSMS to a Monitor position. Allows for voluntary admission through the use of an emergency certificate for patients willing to seek help for mental health needs.
SB 14 focuses on nutrition and bans certain ingredients in schools. Unfortunately it mandates physicians, physicians assistants and nurse practitioners to take nutrition classes as part of CME. It was amended to only require 1 hour every 4 years. LSMS requested removal of the CME. Our oppose position was specific to the CME, not the remaining provisions of the bill.
Oppose
SB 14 by Sen. McMath
Act 463. CME effective 2026.
Oppose
HB 575 by Rep. Lauren Ventrella
Act 383. Effective August 1, 2025.
Monitor
SB 182 by Sen. Kirk Talbot
Suspends the use of prior authorization for Medicaid recpients during a declared emergency.
Act 440. Effective August 1, 2025.
Support
SB 120 by Rep. Larry Selders
Act 421. Effective August 1, 2025.
Support
REPRODUCTIVE HEALTHCARE
INSTRUMENT DESCRIPTION
POSITION RESULT
SB 154 by Sen. Jay Morris
Criminlizes the possession or distribution of kratom.
Act 41. Effective August 1, 2025.
Support
SB 156 by Sen. Thomas Pressly
Modernises Louisiana's In Vitro Fertilization statutes.
Act 342. Effective August 1, 2025.
Support
This became a "wrap up" bill for workers' compensation. It establishes a legislative task force to study issues surrounding workers' compensation and make recommendations.
Enrolled. Sent to Secretary of State.
SR 128 by Sen. Patrick McMath
Requires blood testing for HIV and Syphillis as well as screeing for substance use disorder at certain times during pregancy. Requires insurance to cover the associated costs.
Monitor
Act 437. In effect as of June 20, 2025.
SB 174 by Sen. Katrina Andrews
Monitor
PAGE 6
PAGE 7
2025 LEGISLATIVE RECEPTION
A few things should jump out at you from this past session: z Even for a fiscal session, this was a low volume of filed legislation. Many of the pundits who pontificate believe this to be a function of the number of special sessions that have been called in the last several years. It seems special sessions have become the norm and are readily called to focus on specific, high-profile issues. It does beg the question of if special sessions have given legislators the ability to solve constituent needs or keep campaign promises without waiting for a regular/fiscal session. z The range of issues covered in this fiscal session was crazy and unusual! I can’t think of an industry that wasn’t touched by something introduced this year. In fact, the main focus seemed to be on tort reform, auto insurance, workers compensation and boards rather than taxes, fees and
exemptions. It certainly did not classify as boring! We appreciate everyone who took action during the session. We encourage all members to make appointments with your legislators at their district offices. Now is the perfect time to reconnect with them and continue building relationships. The legislative keyword used on 112 instruments was a term of health or medicine. Some of the biggest debates of session focused on PBMs, public health, new causes of action in medicine and the LSBME…not taxes, fees or finances. Following is a focused table of some of the bigger instruments LSMS tracked in 2025: Keywords Tracked Abortion 3 Athletic Trainer 1 Behavioral Health 2 Prescription Drugs 1 Health 5 Health Care 12 Health Care/Facilities 2
Health Care/Providers Health Department
3 2 5 5 1 1 1 1 3 1 2 2 8 1
Health Services
Health/Acc Insurance Health/Anatomical Gifts
Health/Cancer Health/Children
Health/Emerg Med Service
Health/LDH
Health/Medical Treatment Health/School Clinics Office of Group Benefits
Health Insurance
Med Mal Medicaid
17
MCO
1 3 2 3 1 3 2 1 1 2
Mental Health SANE Nurses
Nutrition
Pharmaceuticals
Pharmacies Pharmacists
PTs PAs
Physicians
Public Health
10
Speech Path/Audiology
1 1
Substance Abuse Workers Comp
2 112
health. During April, the coalition hosted a bourbon and barbeque reception at the state Capitol, and in May held its annual White Coat Wednesday. The members of the 2025 Physician Coalition of Louisiana include: z Louisiana State Medical Society z Louisiana Academy of Family Physicians z LA Chapter, American Academy of Pediatrics z Louisiana Psychiatric Medical Association z Louisiana Association of Eye Physicians and Surgeons z Tulane Physicians z Louisiana Orthopaedic Association z Louisiana Osteopathic Medical Association/ VCOM, and Medicine Louisiana z Radiological Society of Louisiana
Formed in 2019, the Physician Coalition of Louisiana is a partnership between the Louisiana Academy of Family Physicians and the Louisiana State Medical Society serving as a unified voice for all physicians and physician medical associations in the State of Louisiana. Each year we solicit specialty medical associations in the state to join the coalition and strengthen our voice. For 2025, our partner groups consisted of more than 8,000 practicing physicians, residents in training, and medical students. The coalition educates patients, lawmakers and the public by providingup-to-date information about issues affecting the practice of medicine and patient
PAGE 8
PAGE 9
2025 WHITE COAT WEDNESDAY
PAGE 10
PAGE 11
17 February 2025 POLITICS AND ADVOCACY CONTINUE YEAR ROUND. LSMS works outside the state legislative session to ensure physicians have a voice in interim committee meetings, the regulatory process and at a federal level. The following communications relate to issues and actions from earlier this year. In February, a coalition of physician groups led by LSMS reinforced the importance of the physician-patient relationship in the ongoing debates regarding vaccines.
COALITION OF STATE MEDICAL ASSOCIATIONS LSMS CONTINUES TO WORK WITH MEDICAL SOCIETIES FROM OTHER STATES TO URGE CONGRESS TO PROTECT MEDICAID FROM BUDGET CUTS.
May 21, 2025
An open letter to Louisiana’s patients regarding immunizations
The Honorable Mike Johnson
The Honorable Hakeem Jeffries
Speaker
Democratic Leader H-204 The Capitol
Immunizations should not be politicized. Healthcare should not be politicized. Public health should not be politicized. Your relationship with your physician should not be politicized.
H-232 The Capitol
U.S. House of Representatives Washington, D.C. 20515
U.S. House of Representatives Washington, D.C. 20515
The Honorable John Thune
The Honorable Charles E. Schumer
Majority Leader
Minority Leader
S-221
S-230
As a patient or caregiver in Louisiana, you have a right to have your questions regarding immunizations answered in a responsible, physician-led, knowledge-driven, evidence-based manner. The very best person to answer your questions is your physician. To that end, it is important for patients to have physicians and to be reassured that immunizations remain essential to supporting healthy communities. They are one of the most significant medical innovations of our time and have proven to be an invaluable thread in the fabric of our society. Traditional vaccinations have greatly impacted the spread of (and in some cases nearly eradicated): Polio, Smallpox, Tetanus, Hepatitis B, Hepatitis A, Rubella, Hib, Influenza, Measles, Pertussis, Pneumococcal Disease, Rotavirus, Varicella, Diphtheria and Mumps. In children, vaccinations help to prepare their immune system to recognize and respond to serious diseases. This helps them to stay healthy so they can thrive and develop into adulthood. Adults are also eligible for vaccines to include boosters for immunizations given during adolescence. In addition to childhood shots and/or boosters, adults are eligible to receive: Human Papillomavirus, Pneumonia, Shingles, and Meningitis. Physicians providing vaccinations to patients do respect a patient’s autonomy and do seek consent. To say otherwise is wrong. However, physicians also have a responsibility to provide patients with accurate information and the risks associated with refusing a vaccine – including illness, hospitalization and the very real prospect of harming vulnerable members of the community who rely on low to non-existent rates of illness to survive. Public health should serve as a partner to physicians by promoting evidence-based vaccine policy which is in the best interest of the patient. Here in Louisiana, physicians are today treating whooping cough (Pertussis), a disease that is highly contagious and vaccine preventable. In our neighboring state of Texas, physicians are treating an outbreak of Measles, a disease that had been declared eliminated in the US in 2000. As vaccination rates drop, outbreaks grow. There is no replacement for your physician in this conversation! Talk to your physician today. Louisiana State Medical Society Louisiana Academy of Family Physicians Louisiana Chapter – American Academy of Pediatrics Louisiana Chapter – American College of Emergency Physicians Louisiana Chapter – American College of Physicians Louisiana Chapter – American Congress of Obstetricians and Gynecologists Louisiana Society of Addiction Medicine MedicineLouisiana Radiological Society of Louisiana
U.S. Senate
U.S. Senate
Washington, D.C. 20510
Washington, D.C. 20510
Dear Speaker Johnson, Majority Leader Thune, Democratic Leader Jeffries and Leader Schumer,
On behalf of the undersigned State Medical Associations and the District of Columbia, representing hundreds of thousands of physicians and the 80 million Medicaid patients we serve, we strongly urge Congress to reject the $822 billion in Medicaid cuts included in the House Budget Reconciliation bill. The independent, non-partisan CBO estimates the proposal will result in the loss of coverage for at least 7.6 million Americans on Medicaid, including children, veterans, people with disabilities, seniors, pregnant women and low-income workers. This will lead to even more crowding of emergency departments, closures of rural hospitals and community physician practices, and widespread health and economic instability. Our patients’ health will suffer, the nation’s healthcare system will be in jeopardy, and health care costs will rise. Rural communities will be the hardest hit. This legislation represents a major reversal of long-standing financing agreements between states and the federal government. These massive cuts will devastate state budgets and states will be forced to raise taxes, cut provider payments, and cut Medicaid coverage for millions. As state medical associations, we are specifically concerned with the CBO estimate that shows the provider tax cuts and the state directed payment limit will result in nearly $200 billion in cuts to states, providers and our patients. Our specific comments are listed below: 1. Elimination of provider taxes on hospitals, managed care organizations, nursing homes and other providers – Section 44134. CBO Score: $30 billion cut. We strongly oppose this provision which would effectively eliminate long-standing provider taxes used in many states to support Medicaid. This change will have a catastrophic impact on state budgets, providers, and coverage for Medicaid enrollees and severely threaten the stability of Medicaid, especially in rural communities where hospitals and practices are already operating on thin margins. One-third of American’s rural hospitals are already at risk of closure.
These taxes have been authorized under federal law, approved by both Republican and Democratic administrations, and adopted by state legislatures for decades. Federal law requires states to establish
PAGE 12
PAGE 13
uniform provider taxes on all health plans, hospitals, nursing homes and other providers. These provider taxes must be uniform among providers and plans. This uniformity rule can be waived under strict circumstances and many states have received such waivers. Section 44134 requires all state provider taxes to meet the uniformity rule upon enactment of the legislation. If states cannot immediately meet these requirements, federal funding terminates. The legislation does provide a transition, but it is under the sole discretion of the Secretary of Health and Human Services, which is illusory and unreliable. For many states, the proposal would require increasing taxes on commercial health plans which would force them to increase premiums on employers and individuals purchasing insurance coverage. Medicaid plans on the other hand, often receive indirect benefit as they receive the tax investment back from the state through higher payment rates to safety net providers in plan networks. The uniformity rule will be difficult for states to comply. In states with low proportions of commercially insured individuals restructuring their programs to meet these new requirements will be near impossible without massive tax increases resulting in higher premiums. States unable to comply in such an accelerated time frame will face a fiscal crisis, be forced to cut coverage or raise taxes. We respectfully urge Congress to eliminate this provision in the bill. If it remains, Congress should consider a clear and reliable transition period that gives states time to restructure to come into compliance or wind down programs and services.
4. Cost-Sharing Requirements on Very Low-Income Medicaid Expansion Adults We oppose new cost-sharing mandates on extremely low-income Medicaid enrollees. A $35 copay/visit or a 5% income contribution on an income of $15,600 annually, creates a significant barrier to care. Instead, these individuals, many of whom are chronically ill or disabled, will end up hospitalized, driving up costs. Physicians are rarely able to collect such payments from patients effectively making this a provider pay cut.
We urge Congress to remove this provision.
5. Administrative Barriers to Eligibility and Provider Participation. CBO Score: We are concerned that administrative burdens and frequent paperwork requirements to demonstrate employment status and other components of the program will result in legitimately eligible enrollees losing coverage. Moreover, the bill requires states to verify provider enrollment on a monthly basis which will discourage provider participation.
We urge Congress to reduce redundant administrative burdens that keep legitimately eligible patients and physicians off the program.
State Medical Associations and physicians nationwide urge Congress to reject the harmful cuts to Medicaid. Instead, we encourage you to protect and strengthen Medicaid – a proven, cost-effective safety net that serves 80 million vulnerable Americans.
2. Moratorium and Freeze on Provider Taxes – Section 44132. CBO Score: $87 billion cut.
Thank you for your support of physicians and the patients we serve.
We strongly oppose the proposed moratorium and freeze on provider taxes. This freeze amounts to a long- term funding cut as it will not keep pace with increasing health care costs brought on by inflation, economic downturns, public health crises and natural disasters. States will end up reducing coverage and benefits for Medicaid recipients that diminish care, especially in rural communities. Additionally, the moratorium penalizes states that may seek to adopt a provider tax in the future to maintain access, expand behavioral health services or respond to emergencies like the opioid crisis.
Medical Society of Virginia Michigan State Medical Society Minnesota Medical Association
Sincerely,
Alaska State Medical Association Arkansas Medical Society California Medical Association Colorado Medical Society Connecticut State Medical Society Florida Medical Association Hawaii Medical Association Idaho Medical Association Illinois State Medical Society
Mississippi State Medical Association Missouri State Medical Association
Montana Medical Association Nebraska Medical Association New Mexico Medical Society
We urge Congress to remove this proposal.
3. Payment Limits on State Directed Payments - Section 44133. CBO Score: $80 billion cut.
North Dakota Medical Association Ohio State Medical Association Oklahoma State Medical Association Oregon Medical Association Pennsylvania Medical Society Rhode Island Medical Society South Dakota State Medical Association Tennessee Medical Association
We oppose the proposed Medicare payment cap on the State Directed Payments. The provision will negatively impact public hospitals and physician specialists who care for the most complex and critically ill patients across the country. These limits will reduce access to care which is equivalent to coverage losses. The Medicare physician fee schedule is an inadequate benchmark for state directed Medicaid payments. When adjusted for inflation, Medicare payments have declined by 33% over the past two decades and do not cover the costs to provide care. The Medicare Payment Advisory Commission (MedPAC) and the Medicare Trustees have warned Congress that these inadequate payments are limiting access to care.
Indiana State Medical Association Louisiana State Medical Society Maine Medical Association Massachusetts Medical Society MedChi, The Maryland State Medical Society Medical Association of Alabama Medical Society of Delaware Medical Society of New Jersey Medical Society of the District of Columbia
Texas Medical Association Utah Medical Association Vermont Medical Society
We urge Congress to remove this provision.
Washington State Medical Association West Virginia State Medical Association Wisconsin Medical Society
Medical Society of Virginia Michigan State Medical Society Minnesota Medical Association
Mississippi State Medical Association Missouri State Medical Association Montana Medical Association
PAGE 14
PAGE 15
COALITION OF STATE MEDICAL ASSOCIATIONS
Provider taxes have played a vital role in stabilizing the health care system for both providers and patients because Medicaid consistently pays below the cost of providing care. These funding sources have helped providers across the nation remain accessible to patients during the COVID pandemic, economic recessions, and natural disasters. If these cuts are enacted, it will create devastating gaps in State budgets that are already experiencing deficits, forcing states to raise taxes, or reduce Medicaid benefits, coverage, and provider payments. These reductions will lead to even more crowding of emergency departments and as the uncompensated care burdens grow from patients losing coverage, many rural hospitals, nursing homes, and community physician practices will be forced to close to all patients. These closures will create widespread health and economic instability, particularly in rural communities. Many of our rural hospitals, often the largest employer in the community, are already at risk of closure and provider taxes have literally kept them open and protected local jobs. Contrary to some assertions, provider tax cuts will force states to cut benefits and access to care for the traditional Medicaid population of children, veterans, seniors, people with disabilities, and pregnant women. The additional Senate Medicaid cuts that reduce the safe harbor tax caps from 6% to 3.5% in the 41 red and blue states that expanded Medicaid, unjustly harms the vast majority of states. Studies show that patient health status improved in these 41 states which also reduced health care costs. The new Senate Medicare payment caps for State Directed Payments at a percent of Medicare penalizes public hospital systems and physician specialists caring for some of the sickest patients across the nation. The Moratorium on new provider taxes and a freeze on provider tax levels amounts to a long-term funding cut, as the funding will not keep pace with increased health care costs over time brought on by inflation, economic downturns, public health crises and natural disasters. It also inequitably freezes rates in states with lower taxes. The Uniformity Requirement for all provider taxes on hospitals, nursing homes, and managed care organizations to be equal in each provider category is essentially an elimination of numerous provider taxes across the nation because states would experience extreme difficulty meeting the rules and would need more time to try to restructure or unwind existing programs and services.
June 24, 2025
The Honorable John Thune
The Honorable Charles E. Schumer
Majority Leader
Minority Leader
U.S. Senate
U.S. Senate
S-221
S-230
Washington, D.C. 20510
Washington, D.C. 20510
The Honorable Michael D. Crapo
The Honorable Ron Wyden
Chairman
Ranking Member
Senate Finance Committee
Senate Finance Committee
U.S. Senate
U.S. Senate
SD-239
SD-221
Washington, D.C. 20510
Washington, D.C. 20510
Dear Majority Leader Thune, Leader Schumer, Chairman Crapo, and Ranking Member Wyden,
On behalf of the undersigned State Medical Associations and the District of Columbia, representing hundreds of thousands of physicians and the 80 million Medicaid patients we serve, we are writing to urge the Senate to reject the damaging cuts to Medicaid, Medicare, and medical student loan programs in the Senate Finance Committee draft budget reconciliation bill. These cuts will seriously harm access to health care for all Americans. The Senate plan threatens hospital and physician viability and our patients’ health, particularly in rural communities; creates barriers to medical school and exacerbates physician shortages; and fails to address chronically inadequate Medicare physician payments that are causing serious access to care challenges for America’s seniors. As physicians and stewards of our nation’s health, we urge you to find more balanced solutions that protect the nation’s health and well-being. Unfortunately, the Senate bill increases the Medicaid cuts by nearly $200 billion over the House cuts – reaching over $900 billion in cuts to Medicaid – and will result in further unnecessary losses of coverage and access to care. Combined with the large Medicare physician cuts, the Senate bill will cause a wholesale shift of uncompensated care to states and an already fraying safety net of physicians, clinics, and hospitals. State budgets will be crippled. Patient conditions will worsen as they wait for hours in emergency departments or months to see a primary care physician and health care costs will increase.
Coalition Recommendations:
1. Eliminate Provider Tax Cuts + Eliminate the Provider Tax Uniformity Requirement that essentially terminates numerous provider taxes in multiple states because the rules are so difficult to meet. If this provision is not removed, this requirement would necessitate much more time for states to come into compliance or wind down existing services. Section 71122. + Eliminate the Senate safe harbor tax rate limits from 6% to 3.5% and the Medicare payment limits on state directed payments. Sections 71120 and 71121.
The Coalition urges you to consider the recommendations below.
Medicaid Provider Taxes in 49 States Are Not “Waste, Fraud, and Abuse” These taxes have helped states meet the mountain of increased demand for health care services from an ever-growing population with more serious chronic conditions. The accusations that Provider taxes are waste, fraud and abuse are unfounded, as these programs have helped millions of people get the medical care they need. Provider taxes have been authorized under federal law, approved by both Republican and Democratic administrations, and affirmed by state legislatures in 49 states for decades. They are a legitimate financing mechanism used by states in partnership with the federal government to fund essential health services and have kept rural hospitals, maternity wards, nursing homes, behavioral health clinics, and physician practices open.
+ Eliminate the Moratorium on new and increased taxes. Section 77120.
PAGE 16
PAGE 17
2. Reduce Work Requirement Administrative Red-Tape Reduce the administrative barriers to demonstrating work status and give states the flexibility to design programs that work best for our states and our Medicaid populations. 3. Reverse the Student Loan Cuts that Exacerbate Physician Shortages + Raise the $150,000 cap on undergraduate and medical school borrowing for students pursuing careers in medicine as the average medical student debt is at least $250,000 and + Reinstate the ability for medical residents in training to apply the long hours worked in public institutions to count toward federal Public Service Loan forgiveness (PSLF). 2. Reduce Work Requirement Administrative Red-Tape Reduce the administrative barriers to demonstrating work status and give states the flexibility to design programs that work best for our states and our Medicaid populations. 4. Increase Medicare Physician Payment and Seniors’ Ability to Access Timely Care The Senate bill fails to address the deplorable Medicare physician payment rates and the corresponding access to care problems experienced by our senior patients. Medicare physician payment rates have declined by 33% since 2001, when adj usted for inflation and are not keeping pace with the rising costs to operate a medical practice. These woefully inadequate rates have forced physicians to consolidate which has driven up health care costs. The rates are also causing more physicians to reduce the number of Medicare patients they accept or retire early and close their doors. Medicare patients are experiencing longer wait times to see both primary care and specialist physicians. Both MedPAC and the Medicare Trustees are reporting that the low rates are negatively impacting seniors access to physicians. physicians to reduce the number of Medicare patients they accept or retire early and close their doors. Medicare patients are experiencing longer wait times to see both primary care and specialist physicians. Both MedPAC and the Medicare Trustees are reporting that the low rates are negatively impacting seniors access to physicians. Therefore, we urge the Senate to stop the 2.8% payment cut physicians experienced in 2025 and provide an inflation update to keep pace with rising costs to operate a medical practice. 3. Reverse the Student Loan Cuts that Exacerbate Physician Shortages + Raise the $150,000 cap on undergraduate and medical school borrowing for students pursuing careers in medicine as the average medical student debt is at least $250,000 and + Reinstate the ability for medical residents in training to apply the long hours worked in public institutions to count toward federal Public Service Loan forgiveness (PSLF). 4. Increase Medicare Physician Payment and Seniors’ Ability to Access Timely Care The Senate bill fails to address the deplorable Medicare physician payment rates and the corresponding access to care problems experienced by our senior patients. Medicare physician payment rates have declined by 33% since 2001, when adj usted for inflation and are not keeping pace with the rising costs to operate a medical practice. These woefully inadequate rates have forced physicians to consolidate which has driven up health care costs. The rates are also causing more
AMERICAN SOCIETY OF MEDICAL ASSOCIATION COUNSEL
FREEMAN ELECTED AS VICE CHAIR OF THE AMA SOUTHEASTERN DELEGATION
In June, William T. Freeman, MD, a board-certified emergency physician from Prairieville, was elected as the vice-chair of the AMA Southeastern Delegation or SED. The SED is a self-directed coalition of states within the American Medical Association (AMA) for communication and action on relevant issues and projects. The SED currently includes the delegations from sixteen members states: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, New Jersey, North Carolina, Oklahoma, South Carolina, Tennessee, Virginia, and West Virgina, plus the Commonwealth of Puerto Rico and the District of Columbia. Each state has one representative on the Board of Directors who shares information within their respective states. The SED works within the American Medical Association to promote Southeastern Delegation interests, projects and points of view. Freeman will serve a two-year term through June 2027.
The American Society of the Medical Association Counsel (ASMAC) is the premier network of specialized healthcare attorneys and advocates nationwide dedicated to the mission of organized medicine and the representation of physicians. Its members include a highly specialized and focused group of attorneys of the medical societies across the country as well as private practice attorneys who represent physicians on all fronts. We are proud to announce at the Annual Meeting of ASMAC held on June 9, 2025, LSMS’ Vice President of Legal Affairs, Lauren Bailey, was elected as the Secretary/Treasurer of the Board of Directors. Ms. Bailey had served as an At-Large Director of the Board during the prior year.
Maine Medical Association Massachusetts Medical Society MedChi, The Maryland State Medical Society Medical Association of Alabama Medical Society of Delaware Medical Society of New Jersey Medical Society of the District of Columbia Medical Society of Virginia
Therefore, we urge the Senate to stop the 2.8% payment cut physicians experienced in 2025 and provide an inflation update to keep pace with rising costs to operate a medical practice.
Michigan State Medical Society Minnesota Medical Association
The Coalition of State Medical Associations urge you to consider these recommendations to reverse many of the damaging cuts to Medicaid, Medicare and student loan programs, and ensure patient access to affordable health care and a stable physician workforce for generations to come. Mississippi State Medical Association Missouri State Medical Association The Coalition of State Medical Associations urge you to consider these recommendations to reverse many of the damaging cuts to Medicaid, Medicare and student loan programs, and ensure patient access to affordable health care and a stable physician workforce for generations to come.
Montana Medical Association Nebraska Medical Association New Hampshire Medical Society New Mexico Medical Society North Carolina Medical Society North Dakota Medical Association Ohio State Medical Association Oklahoma State Medical Association Oregon Medical Association Pennsylvania Medical Society Rhode Island Medical Society South Dakota State Medical Association Tennessee Medical Association
Maine Medical Association Massachusetts Medical Society MedChi, The Maryland State Medical Society Medical Association of Alabama Medical Society of Delaware Medical Society of New Jersey Medical Society of the District of Columbia Medical Society of Virginia
Thank you for your support of physicians and our patients. Thank you for your support of physicians and our patients.
Sincerely,
Alaska State Medical Association Arizona Medical Association Arkansas Medical Society California Medical Association Colorado Medical Society Connecticut State Medical Society Florida Medical Association Hawaii Medical Association Idaho Medical Association Iowa Medical Society Indiana State Medical Association Kansas Medical Society Louisiana State Medical Society Maine Medical Association Massachusetts Medical Society MedChi, The Maryland State Medical Society Medical Association of Alabama Medical Society of Delaware Medical Society of New Jersey Medical Society of the District of Columbia Medical Society of Virginia Alaska State Medical Association Arizona Medical Association Arkansas Medical Society California Medical Association Colorado Medical Society Connecticut State Medical Society Florida Medical Association Hawaii Medical Association Idaho Medical Association Iowa Medical Society Indiana State Medical Association Kansas Medical Society Louisiana State Medical Society
WE WILL MISS YOU TERRI! It is with mixed emotions that we announce the recent departure of Terri Watson, Vice President of Finance and Adminstration, from LSMS. Terri left us in April and while we are sad to see her go, we are also excited for her new journey ahead.
Michigan State Medical Society Minnesota Medical Association
Mississippi State Medical Association Missouri State Medical Association Montana Medical Association Nebraska Medical Association New Hampshire Medical Society New Mexico Medical Society North Carolina Medical Society North Dakota Medical Association Ohio State Medical Association Oklahoma State Medical Association Oregon Medical Association Pennsylvania Medical Society Rhode Island Medical Society South Dakota State Medical Association Tennessee Medical Association
Texas Medical Association Utah Medical Association Vermont Medical Society
During Terri’s seventeen (17) years with the LSMS, she was an integral part of our team, most recently as part of the executive leadership team, contributing significantly to our projects and fostering a positive work environment. Her dedication, creativity, teamwork, and friendship were truly appreciated by all of us. As we deal with this transition, we want to ensure a smooth handover of Terri’s responsibilities. As such, different employees will be stepping in to manage these duties until a permanent replacement is found. In the interim, please reach out to any of us for assistance or questions during this period at publicaffairs@lsms.org. Thank you for your understanding and support during this time of transition. Sincerely, The LSMS Staff
Washington State Medical Association West Virginia State Medical Association
Wisconsin Medical Society Wyoming Medical Society
PAGE 18
PAGE 19
Michigan State Medical Society Minnesota Medical Association
Texas Medical Association Utah Medical Association
Stability, Strength and Service We’re here to help you navigate these changing times. With more than 40 years of experience, LAMMICO provides medical professional liability insurance coverage so that you can practice with confidence – confidence that your coverage is reliable and your reputation will be protected. Aggressive legal defense, personalized claim handling and accredited risk- management education are the bedrock of our business. Our dedication, financial strength and rock solid track record ensure that with LAMMICO as your partner, you can focus on what matters most: your patients .
lammico.com 800.452.2120
Page 1 Page 2-3 Page 4-5 Page 6-7 Page 8-9 Page 10-11 Page 12-13 Page 14-15 Page 16-17 Page 18-19 Page 20Made with FlippingBook Digital Publishing Software