Nearly half of Americans say they can't afford quality healthcare — and that was before ACA premium credits expired and Medicaid cuts kicked in. AMGA President and CEO Jerry Penso, M.D., argues that medical groups aren't waiting for a policy mandate to act: they're already redesigning care, shifting procedures to outpatient settings, and expanding team-based models with nurse practitioners and physician assistants (now ~48% of AMGA's provider workforce) to lower costs without sacrificing quality.

The problem? The payment system isn't keeping up. The Medicare physician fee schedule conversion factor is lower in real terms today than it was in 2010, while practice costs have risen ~20% over the same period. On top of that, Medicaid cuts from the One Big Beautiful Bill Act are projected to slash federal Medicaid spending by over $900 billion through 2034 — and providers are already feeling the squeeze.

By the Numbers:

• 38% of AMGA survey respondents are already cutting patient services in anticipation of Medicaid cuts
• 68% plan future service cuts
• 21% expect to close or restructure facilities
• 64% anticipate employee layoffs or furloughs
• 53 million prior authorization requests processed in Medicare Advantage alone each year
• Administrative burden consumes ~12–15 cents of every premium dollar

Why it matters: Providers are doing the heavy lifting on affordability, but chronic underpayment and administrative friction are undermining those efforts. Penso's call to action: stabilize Medicare payments and streamline prior authorization — not new mandates — to let the system's cost-cutters actually do their jobs.