Midterm sweep gives physician pay reform an opening in 2027, MGMA's Anders Gilberg says

Democrats take full control of Congress in January, and physician advocates see an opening for the Medicare payment overhaul they have chased for years. First, though, the outgoing Republican majorities have until Dec. 11 to decide whether to stop a pay cut that lands Jan. 1.

"I do believe that this Congress will focus more on health care," Anders Gilberg, senior vice president of government affairs at MGMA, told Physicians Practice in a Nov. 10 interview. "Health care will definitely be in the discussion more than I would have otherwise expected with the Democrats in charge."

What the midterms changed

Democrats flipped seven Senate seats on Nov. 3, in North Carolina, South Carolina, Ohio, Texas, Kansas, Iowa and Maine, according to NPR. Early AP counts put the Senate at 54-44 with races in Alaska and Mississippi undecided and the House at 228-139 with several races still outstanding.

The physician bloc in Congress is shifting, too. Rep. Greg Murphy, R-N.C., a urologist, conceded his race to Democrat Raymond Smith on Nov. 11 after provisional ballots put Smith ahead, NC Newsline reported. That leaves 11 Democratic physicians and nine Republican physicians in the 120th Congress, by the American College of Gastroenterology's count, for 20 total, matching the record. ACG says it will be the first time in decades that Democratic physicians outnumber Republicans. Medical Economics profiled the physicians headed to Congress.

"The fact that we have more and more physicians of both parties as actual working members of Congress definitely helps in terms of the focus on health care," Gilberg said.

The lame duck comes first

Republicans control both chambers until the new Congress is seated in January, and federal funding expires Dec. 11. Any health care legislation that passes this year will almost certainly ride on a government funding bill, STAT reported.

The stakes for practices are immediate. The final 2027 Medicare Physician Fee Schedule cuts the conversion factor for clinicians outside an advanced alternative payment model 2.31 percent, to $32.63, according to the CMS fact sheet. Much of that cut reflects the expiration of the one-year 2.5 percent increase Congress approved for 2026.

MGMA laid out its year-end asks in a Nov. 9 letter to House and Senate leaders: prevent the 2027 cuts, stop the cut to same-day services, extend the advanced APM incentive payment and the 1.0 work geographic practice cost index floor, freeze qualifying participant thresholds, pass prior authorization reform and prevent clinical lab cuts.

"Last year, as part of some of the extenders, we call them, for health care, there was a two and a half percent increase to the physician payment, the conversion factor. We would like to see that again," Gilberg said.

The geographic floor, which keeps the physician work adjustment from dropping below 1.0 in rural and lower-cost areas, cuts across party lines, Gilberg said. He pointed to North Carolina, whose statewide work index would sit at 0.991 without the floor, according to 2026 CMS values compiled by CGM. "There are Republican and Democratic members of Congress from North Carolina who do not want to see all of their physicians penalized as a result of that," he said. He also flagged lab cuts that would hit physician office labs, which MGMA estimates would average about 16 percent, phased in over three years.

Gilberg also singled out the Improving Seniors' Timely Access to Care Act, which would require electronic prior authorization in Medicare Advantage. The bill had 298 House cosponsors and 71 Senate cosponsors as of July 21, according to the American Academy of Physical Medicine and Rehabilitation, and the Congressional Budget Office scored it at zero cost in 2024, according to its sponsors.

"We have a super majority of sponsors. It doesn't cost anything, according to the Congressional Budget Office. There's no reason that bill shouldn't pass this fall," he said.

He still sees time for a year-end package, "unless there's a big blow up unrelated to health care that just causes maybe the Republicans to walk away and then say we'll deal with this in the new year." History favors the lame duck. The 119th Congress had enacted 121 laws as of Oct. 14, the second fewest of any Congress in four decades, Pew Research Center found. Its predecessor passed 61 percent of the measures it enacted during the lame-duck period.

What a Democratic Congress may take up first

Gilberg expects the new majority to start with coverage. "I'm pretty sure H.R. 1, or one of the very first bills out of the gate, will deal with the Medicaid cuts that were put into effect in the One Big Beautiful Bill," he said, whether through work requirements and related policies or the ACA subsidies that were allowed to expire.

Physician pay is on the list, too. A Sept. 1 memo to Minority Leader Hakeem Jeffries from the House Democrats' Cost-of-Living Healthcare Working Group, co-led by Reps. Alexandria Ocasio-Cortez, D-N.Y., and Terri Sewell, D-Ala., puts restoring the enhanced ACA premium tax credits in its first 100 hours and the Patients First Act (H.R. 9693) in its first 100 days. The bipartisan bill, written by leaders of the GOP and Democratic doctors caucuses, would tie annual physician updates to the Medicare Economic Index, raise the budget neutrality threshold and replace MIPS, as Physicians Practice explained in September.

The bill had 69 cosponsors as of Nov. 5, according to the AMA. Two of its three lead sponsors, Reps. John Joyce, R-Pa., and Kim Schrier, D-Wash., won reelection; the third is Murphy, who leaves office in January. MGMA's Nov. 4 statement on the final fee schedule urged Congress to "prioritize comprehensive MACRA reform by passing the Patients First Act."

Where it could stall

Gilberg flagged two risks. The first is Democrats' own split on health care. "There are some that are very much in the Medicare for All camp," he said. The working group memo lists the Medicare for All Act, which it says has 114 Democratic cosponsors, among its first-year items.

"The physician payment issue is important, but of course things that cut beneficiaries, voters, all of that are also very important," Gilberg said. "So those will probably take precedence, and we will be close behind them on some of our priorities."

The second is the political climate. Rep. Thomas Massie, R-Ky., forced a vote this week on articles of impeachment against Defense Secretary Pete Hegseth. The House voted 211-204 on Nov. 10 to refer them to committee, effectively ending the effort for this Congress, though Democrats have promised investigations of the Pentagon once they hold the majority. Gilberg also expects oversight hearings on HHS, on questions such as why measles has surged. The U.S. recorded more measles cases in 2025 than in three decades, NPR reported in April.

"If they just go to war with the president, impeachment of the president, impeachment of different cabinet officials, then a lot of the things where there is policy agreement could be affected," Gilberg said. "It's more the climate that is created by a lot of this." He expects Democrats to approach it "with a little bit of balance, having learned from the past."

What practices should watch

The near-term question is whether any of MGMA's asks ride on the December funding bill. If they do not, the lower 2027 conversion factor and the 20 percent same-day payment reduction take effect Jan. 1. If they do, Gilberg said, Congress could stabilize payment now and "clear the decks" for longer-term reform when the new majorities take over in January.