As Congress returns from recess, the California Medical Association (CMA) is urging lawmakers to take immediate action on several critical health care priorities that will have a profound impact on whether California patients can continue to access affordable, timely medical care.

Protecting Coverage and Affordability

CMA is calling on Congress to extend the Affordable Care Act enhanced federal premium tax credits that help nearly two million Californians afford health insurance. If the credits are allowed to expire this year, families could see premium increases averaging 97% — about $1,500 annually — forcing many to drop coverage altogether. Such coverage losses would overwhelm hospitals and medical practices with uncompensated care.

Stabilizing Medicare for Seniors

CMA is also urging Congress to increase Medicare payments, noting that Medicare physician reimbursement has dropped 33% since 2001 with no annual inflation adjustment. A recent CMA survey found that 76% of physicians say Medicare no longer covers their costs, and 45% plan to retire early or reduce their patient load. Without action, seniors could face even longer wait times — already up to six months in many parts of California.

CMA is specifically calling on Congress to ensure physicians can continue to care for seniors in their communities by:

• Providing a Medicare physician inflation update;
• Waiving the looming 4% Medicare sequestration cuts; and

The association is also pressing for the extension of pandemic-era telehealth waivers, which allow patients to receive care from home, not just in rural areas. Bipartisan legislation (HR 4206, the CONNECT for Health Act of 2025) would make these waivers permanent.

In addition, CMA is calling for continued funding of key programs that address California’s physician shortage, including:

• The Teaching Health Center Graduate Medical Education program; and
• The National Health Service Corps, which provides scholarships and loan repayment for primary care physicians in underserved areas.

Cutting Red Tape and Lowering Drug Costs

CMA is urging the passage of bipartisan legislation to rein in prior authorization abuses by Medicare Advantage plans (HR 3514/S 1816). According to survey data from the American Medical Association, 93% of physicians report care delays due to prior authorization, and 91% say it harms patient outcomes. The legislation would require faster plan responses, public reporting and disclosure of AI tools used in decision-making.

Finally, CMA is calling on Congress to pass the bipartisan Pharmacy Benefit Manager (PBM) Reform Act of 2025 to lower prescription drug costs by banning spread pricing, increasing transparency, and decoupling PBM compensation from drug prices.

Looking Ahead

In a letter to the California congressional delegation, CMA stressed that Congress must not wait until the eleventh hour to act on these critical priorities. Each delay increases uncertainty for patients, drives more physicians out of practice and erodes California’s progress in expanding health coverage. The decisions lawmakers make in the coming weeks will determine whether seniors can find a physician when they need one, whether working families can afford their health insurance, and whether vulnerable communities continue to have access to care.

“These reforms are essential to protecting access to medical care for millions of Californians, sustaining physician practices that provide essential health care, and building the physician workforce our communities need,” said CMA President Shannon Udovic-Constant, M.D.

CMA will continue to press lawmakers on both sides of the aisle to ensure these reforms are enacted this year.