Senate unveils budget proposal that ditches House’s radiologist Medicare pay hike
The U.S. Senate Finance Committee late Monday unveiled its version of a 2026 budget proposal, which excludes a Medicare pay hike for radiologists and other physicians.
On May 22, the House passed its own version of the reconciliation bill, outlining a physician reimbursement update for next year at 75% of the Medicare Economic Index (MEI), a measure of inflation. However, Senate Finance has now stripped this suggestion from its version of the proposal, drawing criticism from the healthcare industry.
“The House’s MEI adjustment changed the trajectory for the Medicare [Physician] Fee Schedule from a negative to a positive,” Rep. Greg Murphy, MD, R-N.C., a practicing surgeon and advocate for doc pay reform on the Hill, said in a social media post Monday morning before the Senate bill was officially released. “Without it results in death of private practice which leads to consolidation resulting in increased costs and worsening patient care. The Senate needs to realize this.”
Linda Wilgus, co-executive director of the Radiology Business Management Association, said the organization is “deeply disappointed” with the Senate’s initial proposal. Radiology practices are grappling with “escalating” costs for equipment, supplies, salaries and rent and desperately need annual payment updates that reflect rising expenses.
“This policy failure is especially damaging to radiology, a high-volume specialty at the heart of modern diagnostics,” she told Radiology Business by email. “The MPFS’s budget-neutral structure means that every new procedure added results in cuts to existing services—cuts that disproportionately impact radiologists … Without meaningful reform, patient access to essential imaging services will continue to erode.”
While the initial Senate Finance proposal excludes physician payment reform, there will be further opportunities to address this issue, said Dana Smetherman, MD, MBA, MPH, chief executive of the American College of Radiology. There are “many steps to come” in the reconciliation process, including deliberation within the full Senate, along with future negotiations to reach agreement with the House-passed version.
“Not including these payment reforms in the Finance Committee proposal is not a positive sign that Congress will address these long-standing issues in this bill,” Smetherman told Radiology Business. “Still, the bill is far from done. There will also be other legislative vehicles to be considered by Congress this year. The American College of Radiology will continue to advocate for radiologists, their practices, and their patients and work to have our priorities addressed during this Congress.”
So, what’s in the 549-page budget document released late Monday? Republican senators are proposing to make many of the core elements of their 2017 tax cuts permanent, according to a bill breakdown from The Hill. Senate Finance also is taking a “bigger swing” at Medicaid cuts in its version. They’re suggesting effectively capping provider taxes at 3.5% by 2031, down from the current 6%, according to the outlet, but only for states that expanded Medicaid under the Affordable Care Act.
Non-expansion states also would be barred from imposing new taxes, with rates frozen at current levels. The lower cap wouldn’t apply to nursing homes or intermediate care facilities. Senate Finance also wants to cut certain existing, state-directed payments to hospitals, a “significant hit” to the field’s bottom line, according to the report.
“The legislation also achieves significant savings by slashing Green New Deal spending and targeting waste, fraud and abuse in spending programs while preserving and protecting them for the most vulnerable,” Senate Finance Committee Chairman Mike Crapo, R-Idaho, said in a statement June 16. “I look forward to continued coordination with our colleagues in the House and the administration to deliver President Trump’s bold economic agenda for the American people as quickly as possible.”
Cuts to Medicaid have drawn ire from the American Hospital Association, among others, which criticized the proposal late Monday.
“We continue to review the Senate Finance Committee’s proposal. However, it appears that the provisions further undermine the ability for hospitals to provide care to Medicaid patients. This bill moves in the wrong direction,” AHA CEO Rick Pollack said in a statement. “The magnitude of Medicaid reductions and changes to health insurance marketplaces will shift millions of Americans from insured to uninsured status.”
Congress previously passed a stopgap measure to fund the federal government in March. Lawmakers removed an initially agreed-upon physician pay hike after President Donald Trump and tech billionaire Elon Musk urged lawmakers to make changes to the nearly finalized proposal. Rep. Murphy at the time said the White House had promised to take care of docs via a reconciliation bill later in the year.
“The House of Medicine needs to stand UNITED for the doc fix. Efforts otherwise are undermining the progress that has been made,” Murphy said on social media Monday.
“For months, physicians have been told a fix was coming. Instead, this bill includes nothing but more pain, thanks to deep Medicaid cuts and the removal of language that would have served as a potential framework to stabilize Medicare reimbursement,” Kit Crancer, chair of the RBMA's Radiology Patient Action Network, told Radiology Business late Monday. “These are not abstract policy shifts. They are real, direct threats to patient access and the survival of physician practices across the country. The House bill offered the beginnings of an evidence-based framework rooted in MedPAC’s own recommendations. The Senate’s decision to strip that language is a clear choice to ignore a growing crisis in American healthcare.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.