January 2025 Advocacy Update: Three Issues of Note

Statement from leading physician groups on announcement to withdraw U.S. from the World Health Organization

By Group of Six 01.23.25

The statement below is issued by the American Osteopathic Association, American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, American College of Physicians and American Psychiatric Association:

“The recent announcement to withdraw the United States from the World Health Organization (WHO) will limit our ability to collaborate and coordinate on public health issues that impact individuals and their families here and around the globe. As leading medical organizations representing more than 600,000 physicians in the United States, we share the goal of safe, healthy, and disease-free patients and communities. Remaining part of the WHO is one way we can ensure our nation’s success in achieving this goal for all the patients we care for.

“For more than 70 years, the WHO has played a leading a role in protecting, supporting, and promoting public health in the United States and around the world. Withdrawing from the WHO will hamper our country’s ability to predict and respond to major public health emergencies and limit access, communication and information sharing to a global network of health professionals.

“We urge Congress to reject the administration’s proposal to withdraw from the WHO and ensure the United States can continue to have a seat at the table where critical public health decisions are being made.”

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Medicare Payment Advisory Commission Recommends Tying Medicare payments to growth in cost

The Medicare Payment Advisory Commission on Jan. 16 voted to recommend tying next year’s Medicare physician payment update to the growth in care costs (Becker’s Hospital Review Jan 16. 2025, Alan Condon).

The proposal would be a significant step toward ensuring patient access, according to the American Medical Association. The association supports linking Medicare updates to the Medicare Economic Index but notes that the recommended 2026 update {MEI minus one percentage point) still falls short of covering practice cost inflation.

Despite rising costs, CMS cut Medicare physician pay by 2.8% for 2025 -the fifth consecutive year of cuts -while Medicare Advantage plans are set to see a 4.33% average pay increase from 2025 to 2026.

The American Osteopathic Association {AOA) is also actively advocating against Medicare cuts that could impact physician payments and patient access to care. In comments on the Centers for Medicare & Medicaid Services {CMS) proposed CY2025 Medicare Physician Fee Schedule, AOA highlighted the financial strain on physicians due to the reduction in payment and the need for sustainable Medicare physician payment reform.

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PBM Industry Practices Highlighted in Latest FTC Report

(Summary from Jeremy Selley, DO)

The FTC report details how the three largest PBMs-CVS Caremark, Express Scripts, and OptumRx-engaged in practices that generated over $7.3 billion in revenue from 2017 to 2022 through price markups on specialty generics. The report further reveals:

• Massive Markups: PBMs imposed price increases of hundreds and even thousands of percent on specialty generic drugs, including treatments for cancer, HIV, and heart disease, significantly inflating healthcare costs.
• Self-Dealing and Steering: PBMs reimbursed their own affiliated specialty pharmacies at higher rates than independent pharmacies, creating unfair competition and steering profits to their parent companies.
• Spread Pricing Abuses: PBMs charged plan sponsors more than they paid pharmacies, reaping $1.4 billion in additional income.

The attached picture shows the top 3 companies and their PBMs (CVS Caremark, Express Scripts, and Optum RX).

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Proposition 35 – November 2024

November 5, 2024 Press Release

California Voters Overwhelmingly Approve Proposition 35, Securing Medi-Cal for Nearly 15 Million Residents

Landmark Measure Ensures Dedicated Funding to Protect and Expand Access to Health Care

Sacramento – California voters have resoundingly approved Proposition 35, a transformative initiative that guarantees dedicated, ongoing funding for Medi-Cal. This historic measure secures the future of a program that serves nearly 15 million Californians, including half of the state’s children, seniors, low-income families, and individuals with disabilities. “Prop 35’s passage is a monumental win for patients across California,” said Jodi Hicks, President and CEO of Planned Parenthood Affiliates of California and Co-Chair of the Proposition 35 campaign. “With nearly 85% of Planned Parenthood patients relying on Medi-Cal for health coverage, this measure secures a stable future for those who need it most. Planned Parenthood is proud to have championed this initiative to build a more equitable health care system that benefits all Californians.” By extending an existing levy on health insurance companies, Proposition 35 protects and expands access to services without increasing taxes on individuals. The funds will remain exclusively allocated to health care, bolstering access to emergency services, primary and specialty care, family planning, mental health providers, and community clinics. “For years, California’s health care system has faced significant inequities,” said Francisco Silva, CEO of the California Primary Care Association (CPCA). “With voters’ support of Prop 35, that ends today. This funding ensures that patients across the state have access to the care they need and deserve. On behalf of over 1,300 community clinics, CPCA extends our deepest gratitude to the voters who made this historic change possible.” “This victory is the result of an extraordinary coalition,” said Dustin Corcoran, CEO of the California Medical Association and Co-Chair of the Proposition 35 campaign. “More than 400 organizations representing health care providers, social justice advocates, businesses, and community leaders came together to secure this generational investment. With Prop 35, providers now have the stability to continue serving their communities, while patients can access the care they’ve been promised.”

Implications for Emergency Medicine and Osteopathic Medicine

Proposition 35 is especially significant for those of us in Emergency Medicine and Osteopathic Medicine. For emergency physicians, this measure provides critical financial stability to Medi-Cal-funded EDs, ensuring continued resources to manage high-acuity cases and reduce the strain caused by overcrowding and uncompensated care. It also supports upstream efforts—expanded access to preventive care and mental health services—that help mitigate avoidable ED visits. For osteopathic physicians, Prop 35 reinforces the foundation for delivering holistic, patient-centered care. Dedicated funding for primary care and mental health aligns seamlessly with osteopathic principles and ensures that practices in underserved areas remain viable. Additionally, it strengthens support for residency programs and training opportunities, allowing future DOs to continue addressing health care inequities statewide.

Implementation and Next Steps

Implementation of Proposition 35 will begin in the coming months, with a stakeholder engagement process guiding the allocation of funds to ensure they directly benefit patients and providers.

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