Letter to Nancy Pelosi, House Speaker, and Kevin Mccarthy, Minority Leader - Reps. Bera and Bucshon Lead Over 245 Members in Urging Action on Looming Medicare Physician Payment Cuts That Will Strain Patient Access to Care


By: Tom Tiffany, Peter Welch, Abigail Spanberger, Filemon Vela, Jr., Marc Veasey, Beth Van Duyne, Pete Sessions, William Timmons, GT Thompson, Jr., Susan Wild, Paul Tonko, Nydia Velázquez, Thomas Suozzi, Dina Titus, Bonnie Watson Coleman, Mikie Sherrill, Albio Sires, Chris Smith, Jeff Van Drew, Ann Wagner, Peter Stauber, Haley Stevens, Elissa Slotkin, Tim Walberg, Fred Upton, David Trone, Lori Trahan, John Yarmuth, Mike Simpson, Nikema Williams, Debbie Wasserman Schultz, Greg Steube, Daniel Webster, Darren Soto, Juan Vargas, Michelle Steel, Maxine Waters, Norma Torres, David Valadao, Eric Swalwell, Mike Thompson, Greg Stanton, Bruce Westerman, Terri Sewell, Donald Young, Catherine Cortez Masto, David McKinley, Ron Kind, Mark Pocan, Kim Schrier, Derek Kilmer, Stacey Plaskett, Donald McEachin, Blake Moore, David Kustoff, John Rose, Dusty Johnson, Jim Langevin, Tim Murphy, Conor Lamb, Guy Reschenthaler, John Joyce, Fred Keller, Dan Meuser, Mary Scanlon, Kurt Schrader, Frank Lucas, Markwayne Mullin, Dave Joyce, Tim Ryan, Marcy Kaptur, Bob Latta, Joe Morelle, John Katko, Mondaire Jones, Carolyn Maloney, Nicole Malliotakis, Grace Meng, Kathleen Rice, Susie Lee, Teresa Leger Fernandez, Don Payne, Jr., Bill Pascrell, Jr., Tom Malinowski, Donald Norcross, Annie Kuster, Chris Pappas, Kathy Manning, David Price, Deborah Ross, Steven Palazzo, Billy Long, Blaine Luetkemeyer, Ilhan Omar, Betty McCollum, Dean Phillips, Dan Kildee, John Moolenaar, Chellie Pingree, John Sarbanes, Dutch Ruppersberger, Bill Keating, Stephen Lynch, Seth Moulton, Jim McGovern, Jacob LaTurner, Tracey Mann, Greg Pence, Frank Mrvan, Brad Schneider, Marie Newman, Robin Kelly, Mariannette Miller-Meeks, Kai Kahele, David Scott, Lucy McBath, Maria Salazar, Bill Posey, Al Lawson, Jr., Eleanor Norton, John Larson, Ed Perlmutter, Doug Lamborn, Joe Neguse, Scott Peters, Mike Levin, Alan Lowenthal, Lucille Roybal-Allard, Young Kim, Raul Ruiz, Ted Lieu, Grace Napolitano, Adam Schiff, Jimmy Panetta, Barbara Lee, Debbie Lesko, Ann Kirkpatrick, Tom O'Halleran, Mike Rogers, Glenn Grothman, Jaime Herrera Beutler, Morgan Griffith, Vicente Gonzalez, Ronny Jackson, Lizzie Fletcher, Lance Gooden, Louie Gohmert, Mark Green, Chuck Fleischmann, Jenniffer González-Colón, Mike Doyle, Jr., Chrissy Houlahan, Dwight Evans, Brian Fitzpatrick, Anthony Gonzalez, Bob Gibbs, Bill Johnson, Chris Jacobs, Brian Higgins, Antonio Delgado, Andrew Garbarino, Steven Horsford, Joshua Gottheimer, Richard Hudson, Jr., Michael Guest, Vicky Hartzler, Tom Emmer, Jim Hagedorn, Andy Harris, Clay Higgins, Ron Estes, Bill Foster, Randy Feenstra, Tom Graves, Jr., Carlos Gimenez, Ted Deutch, Scott Franklin, Neal Dunn, Jahana Hayes, Jim Himes, Jimmy Gomez, Mike Garcia, Mark DeSaulnier, Josh Harder, John Garamendi, Ruben Gallego, Raul Grijalva, French Hill, Liz Cheney, Gerry Connolly, John Curtis, Brian Babin, Colin Allred, Henry Cuellar, Michael Burgess, Dan Crenshaw, Steve Cohen, Jim Cooper, Tim Burchett, David Cicilline, Matt Cartwright, Madeleine Dean, Brendan Boyle, Peter DeFazio, Suzanne Bonamici, Tom Cole, Yvette Clarke, Mark Amodei, Donald Bacon, Kelly Armstrong, Alma Adams, G. K. Butterfield, Jr., Emanuel Cleaver II, Angie Craig, Jake Auchincloss, James Comer, Jr., Sharice Davids, Larry Bucshon, André Carson, Rodney Davis, Mike Bost, Raja Krishnamoorthi, Danny Davis, Cindy Axne, Ed Case, Carolyn Bourdeaux, Sanford Bishop, Jr., Buddy Carter, Kathy Castor, Charlie Crist, Jr., Gus Bilirakis, Lisa Blunt Rochester, Jason Crow, Diana DeGette, Lou Correa, Tony Cárdenas, Julia Brownley, Salud Carbajal, Jim Costa, Rick Crawford, Barry Moore, Ami Bera
Date: Oct. 14, 2021
Location: Washington, DC

Dear Speaker Pelosi and Leader McCarthy,

We write to bring your attention to the growing financial uncertainty within the Medicare
payment system and to express our support for congressional action to address upcoming
payment cuts to physicians, therapists, and health care professionals before the end of the year.
The current Medicare payment system does not adequately incentivize high-quality care, and
reimbursement has failed to keep up with inflation. We believe broad systemic reforms to the
payment system are critical to speed the transition to value-based care. However, as Congress
begins the complex process of identifying and considering potential long-term reforms, we
must also create stability by addressing the immediate payment cuts facing health care
professionals. These cuts will strain our health care system and jeopardize patient access to
medically necessary services.

Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) with the goal of
moving away from a fee-for-service payment model to a system that ensures providers are paid
for the work they do to keep patients healthy, not just treat them when they're sick. However,
most practices lack access to qualified, patient-centered alternative payment models under
MACRA. We cannot achieve true high-quality, coordinated care without examining and
addressing the existing barriers in MACRA. In addition, the Medicare Physician Fee Schedule
(PFS) has failed to keep up with inflation and larger increases to some providers must be offset
by cuts to other providers, even if there's no evidence of overpayment, due to a budget neutrality
provision in statute, further contributing to the financial pressure on health care professionals.
While we appreciate increased payments in the Calendar Year (CY) 2021 PFS to physicians
delivering primary care and complex office-based care, we must ensure that any changes do not
result in unintended consequences for specialty care. We hope to work with you on broader,
long-term reform to bring stability to the Medicare payment system, and we ask that you
start that work as soon as possible.

In the interim, health care professionals are facing imminent payment cuts stemming from PFS
adjustments as well as the Medicare sequester and the Statutory Pay-As-You-Go (PAYGO) Act.
We are grateful for the action taken by you and by Committee leadership in the Consolidated
Appropriations Act, 2021 to mitigate the impact of payment cuts initiated by the CY 2021 PFS.
As you know, the Consolidated Appropriations Act contained a 3.75 percent payment adjustment
for all PFS services in CY 2021 as part of the congressional relief provided for the impending
payment cuts. This payment adjustment afforded some short-term stability for health care
professionals struggling with the impact of the COVID-19 pandemic.

This critical piece of congressional relief is expiring at the end of the calendar year and adds to
impending cuts resulting from the expiring moratorium on the 2 percent Medicare sequester and
the 4 percent Medicare payment cut due to PAYGO, which was triggered by the passage of the
American Rescue Plan. The combined impact of the PFS cut, Medicare sequester, and PAYGO
means that all health care professionals are likely facing at least 9 percent in cuts to Medicare
payment, unless Congress takes action. As Congress considers a framework to ensure
appropriate reimbursements and improve the Medicare payment system broadly, we must
act before the end of the year to avert the imminent cuts, including extending the 3.75%
payment adjustment, and provide continued stability for physicians and other health care
professionals. Otherwise, the profound exhaustion from the pandemic combined with the stress
of uncertainty in payments may lead to further retirements, office closures, or reduced staffing,
ultimately limiting patient access to care.

We appreciate your consideration and historical support for this issue and look forward to
continuing to work with you to strengthen our health care system in the near- and long-term.

Ami Bera, M.D.
Member of Congress

Larry Bucshon, M.D.
Member of Congress

Additional Member of Congress Signatories

Alma S. Adams, Ph.D.
Colin Z. Allred
Mark E. Amodei
Kelly Armstrong
Jake Auchincloss
Cynthia Axne
Brian Babin, D.D.S.
Don Bacon
Andy Barr
Gus M. Bilirakis
Sanford D. Bishop, Jr.
Lisa Blunt Rochester
Suzanne Bonamici
Mike Bost
Carolyn Bourdeaux
Brendan F. Boyle
Julia Brownley
Tim Burchett
Michael C. Burgess, M.D.
G. K. Butterfield
Salud Carbajal
Tony Cárdenas
André Carson
Earl L. "Buddy" Carter
Matt Cartwright
Ed Case
Kathy Castor
Liz Cheney
David N. Cicilline
Yvette D. Clarke
Emanuel Cleaver, II
Steve Cohen
Tom Cole
James Comer
Gerald E. Connolly
Jim Cooper
J. Luis Correa
Jim Costa
Angie Craig
Eric A. "Rick" Crawford
Dan Crenshaw
Charlie Crist
Jason Crow
Henry Cuellar
John Curtis
Sharice L. Davids
Danny K. Davis
Rodney Davis
Madeleine Dean
Peter A. DeFazio
Diana DeGette
Antonio Delgado
Mark DeSaulnier
Ted Deutch
Mike Doyle
Neal P. Dunn, M.D.
Tom Emmer
Ron Estes
Dwight Evans
Randy Feenstra
Brian Fitzpatrick
Charles J. "Chuck" Fleischmann
Lizzie Fletcher
Bill Foster
Scott Franklin
Ruben Gallego
John Garamendi
Andrew R. Garbarino
Mike Garcia
Bob Gibbs
Carlos A. Gimenez
Louie Gohmert
Jimmy Gomez
Anthony Gonzalez
Vicente Gonzalez
Jenniffer González-Colón
Lance Gooden
Josh Gottheimer
Sam Graves
Mark E. Green, M.D.
H. Morgan Griffith
Raúl M. Grijalva
Glenn Grothman
Michael Guest
Jim Hagedorn
Josh Harder
Andy Harris, M.D.
Vicky Hartzler
Jahana Hayes
Jaime Herrera Beutler
Brian Higgins
Clay Higgins
J. French Hill
James A. Himes
Steven Horsford
Chrissy Houlahan
Richard Hudson
Ronny L. Jackson, M.D.
Chris Jacobs
Bill Johnson
Dusty Johnson
Mondaire Jones
David P. Joyce
John Joyce, M.D.
Kaiali'i Kahele
Marcy Kaptur
John Katko
William R. Keating
Fred Keller
Mike Kelly
Robin L. Kelly
Trent Kelly
Daniel T. Kildee
Derek Kilmer
Young Kim
Ron Kind
Ann Kirkpatrick
Raja Krishnamoorthi
Ann McLane Kuster
David Kustoff
Conor Lamb
Doug Lamborn
James R. Langevin
John B. Larson
Robert E. Latta
Jake LaTurner
Al Lawson, Jr.
Barbara Lee
Susie Lee
Teresa Leger Fernández
Debbie Lesko
Mike Levin
Ted W. Lieu
Billy Long
Alan Lowenthal
Frank D. Lucas
Blaine Luetkemeyer
Stephen F. Lynch
Tom Malinowski
Nicole Malliotakis
Carolyn B. Maloney
Tracey Mann
Kathy E. Manning
Brian Mast
Lucy McBath
Betty McCollum
A. Donald McEachin
James P. McGovern
David B. McKinley
Grace Meng
Daniel Meuser
Mariannette Miller-Meeks, M.D.
John R. Moolenaar
Barry Moore
Joseph D. Morelle
Seth Moulton
Frank J. Mrvan
Markwayne Mullin
Gregory F. Murphy, M.D.
Grace F. Napolitano
Joe Neguse
Marie Newman
Donald Norcross
Eleanor Holmes Norton
Tom O
Ilhan Omar
Steven M. Palazzo
Jimmy Panetta
Chris Pappas
Bill Pascrell, Jr.
Donald M. Payne, Jr.
Greg Pence
Ed Perlmutter
Scott H. Peters
Dean Phillips
Chellie Pingree
Stacey E. Plaskett
Mark Pocan
Bill Posey
David E. Price
Guy Reschenthaler
Kathleen M. Rice
Mike Rogers
John W. Rose
Deborah K. Ross
Lucille Roybal-Allard
Raul Ruiz, M.D.
C. A. Dutch Ruppersberger
Tim Ryan
Maria Elvira Salazar
John P. Sarbanes
Mary Gay Scanlon
Adam B. Schiff
Bradley S. Schneider
Kurt Schrader
Kim Schrier, M.D.
Austin Scott
David Scott
Pete Sessions
Terri A. Sewell
Mikie Sherrill
Michael K. Simpson
Albio Sires
Elissa Slotkin
Christopher H. Smith
Darren Soto
Abigail Davis Spanberger
Jackie Speier
Greg Stanton
Pete Stauber
Michelle Steel
W. Gregory Steube
Haley Stevens
Thomas R. Suozzi
Eric Swalwell
Glenn "GT" Thompson
Mike Thompson
Thomas P. Tiffany
William R. Timmons IV
Dina Titus
Paul D. Tonko
Norma J. Torres
Lori Trahan
David J. Trone
Fred Upton
David G. Valadao
Jefferson Van Drew
Beth Van Duyne
Juan Vargas
Marc Veasey
Filemon Vela
Nydia M. Velázquez
Ann Wagner
Tim Walberg
Debbie Wasserman Schultz
Maxine Waters
Bonnie Watson Coleman
Daniel Webster
Peter Welch
Bruce Westerman
Susan Wild
Nikema Williams
Joe Wilson
John Yarmuth
Don Young