In episode #14 of Season 2 of "Filibusters & Fine Print," the AMGA team cuts through the seemingly disparate regulations of the Trump Administration and reveals four major policy themes shaping healthcare delivery: systematically shifting care to lower-cost settings, supporting Medicare Advantage as the future of Medicare, scaling mandatory alternative payment models that demonstrate measurable savings, and implementing transparency requirements that use private market rates to inform government payment. Rather than simply explaining what's changing, we explore the "why" behind these decisions—the financial logic, strategic priorities, and interconnected goals driving the administration's approach.

The 2026 Medicare Physician Fee Schedule Final Rule dropped on Halloween, and while it's not quite a horror show this year, it's far from a treat. For the first time, CMS split the conversion factor—creating separate rates of $33.5675 for qualifying APM participants (3.77% increase) and $33.4009 for non-qualifying providers (3.26% increase)—with most of the boost coming from last-minute congressional intervention. The team discussed welcome telehealth flexibilities and new remote patient monitoring codes, but concerns about the mandatory Ambulatory Specialty Model starting in 2027. The fundamental problem remains: Medicare payment rates have fallen 29% over two decades when adjusted for practice costs, and budget neutrality creates a zero-sum game among specialties. AMGA is advocating for systematic reform because the current pattern of annual crises and temporary patches is unsustainable and threatens Medicare beneficiary access to care.

The government shutdown is over, but what did it mean for health care and what's coming next? In this episode, the team breaks down the immediate impacts of the shutdown on Medicare and Medicaid claims processing, why healthcare providers were particularly vulnerable, and what's actually in (and notably missing from) the compromise funding deal that reopened the government. Our panel explores the political chess game that led to the shutdown, including Democrats' push for enhanced Premium Tax Credits that didn't make it into the final agreement. We discuss which critical healthcare policies got extended—including telehealth flexibilities, GPCI floors, Hospital at Home waivers, and Medicaid DSH cut delays—and what the claims reprocessing means for providers.