Op-ed: What medical groups are already doing to make care more affordable, and what's standing in the way

Nearly half of Americans feel unable to afford quality healthcare, a situation that persists despite the expiration of Affordable Care Act premium credits in 2025 and upcoming Medicaid cuts. As a healthcare professional, I've witnessed firsthand how financial concerns about medical expenses have become a common aspect of American life.

Within the healthcare sector, there are various accounts about who is responsible for rising costs, but no consensus on reducing them. Instead of finger-pointing, I'd like to highlight the efforts already underway by medical groups to control costs and present the obstacles they face.

Twenty-five years ago, my father underwent hip replacement surgery and spent five days in the hospital. My brother recently had the same procedure and went home the same day, saving thousands of dollars. The shift to same-day outpatient joint replacement didn't happen by chance—it required redesigning care, investing in infrastructure, and challenging long-standing beliefs about hospital admissions being an inherent part of the process.

When this approach is applied to various procedures being moved or continuing to move to outpatient settings, it represents a substantial cost reduction in U.S. medicine, driven entirely by providers without any policy mandates.

Advanced practice providers (APPs), such as nurse practitioners and physician assistants, now make up approximately 48% of the provider workforce in AMGA's membership. This increase, from a much smaller fraction a decade ago, signifies a strategic reorganization of team-based care, enhancing access and lowering cost per visit without compromising quality.

The U.S. healthcare system relies on a payment foundation that has been chronically inadequate for decades. Medicare and Medicaid together cover about half of all patient visits in the United States. The physician fee schedule conversion factor for Medicare is lower today than in 2010, while the cost of running a medical practice has risen by approximately 20% over the same period.

Additionally, the Medicaid cuts included in The One Big Beautiful Bill Act (H.R. 1) - the most significant reductions to the program in decades - will reduce federal Medicaid spending by over $900 billion between 2025 and 2034.

AMGA's recent survey on the impact of Medicaid cuts reveals that 38% of respondents are cutting patient services due to anticipated cuts, 68% plan to reduce services in the future, 21% intend to close or restructure facilities, and 64% expect employee layoffs or furloughs, including frontline clinicians. The administrative burden of providing care, exemplified by prior authorization, adds to this challenge.

In Medicare Advantage alone, there are an estimated 53 million prior authorization requests annually, with managing insurer requirements consuming roughly 12 to 15 cents of every premium dollar, money that doesn't enhance care quality. One health system executive shared an example of a single imaging denial requiring an email chain with six administrators and two physician leaders to resolve.

When multiplied by 53 million, the cost of administrative burdens like prior authorization doesn't support patient care or affordability.

If policymakers and industry leaders wish to replicate the success seen with my brother's care (affordable care resulting from redesign), the most effective approach isn't a new mandate. It's eliminating the friction currently taxing organizations already working to make care more affordable: stabilizing Medicare physician payments to reflect actual care costs and reducing prior authorization and other administrative burdens that add costs without adding value.

Medical groups aren't waiting for permission to improve affordability. They're already redesigning care delivery, expanding the capabilities of their care teams, and relocating procedures to lower-cost settings. The question isn't whether providers will contribute to this goal. It's whether the rest of the system and the payment policies supporting it will stop working against them while they do so.