Report: Arizona's Involvement in Federal Healthcare Advocacy

The Pulse of Policy: How Arizona’s Delegation is Shaping Medicine at the Federal Level

This past November, the Arizona Medical Association sent its delegation to Washington, D.C., for the American Medical Association’s Interim House of Delegates meeting.

Joined by colleagues from across the nation, Drs. Dowling, Leib, Jasser, Figge, Fagan, Baltazar, Kazi, and Rejbi stepped into the arena representing the voices of Arizona physicians and the profession’s future. The resulting deliberations painted a stark picture of the threats facing the practice of medicine, yet they also illuminated a clear, evidence-based pathway toward stabilization and renewal.

The following is a report of the proceedings, outlining the pathologies threatening our practice and the treatments we are prescribing through aggressive advocacy.

The Economic Siege: Payment Reform and the Private Practice Defense

The meeting opened with the proceedings of the Private Practice Physicians Section (PPPS), a gathering of more than 50 physicians dedicated to preserving the independent model of care. The atmosphere was one of urgent resolve. The central theme was the erosion of economic viability, specifically regarding the recently announced Medicaid reductions.

For Arizona, where Medicaid (AHCCCS) plays a vital role in our safety net, these reductions are not abstract budget adjustments; they are physiological shocks to the healthcare system. The delegation analyzed how these cuts threaten to alter care delivery and destabilize practice revenue. The consensus was clear: passive acceptance is not a strategy. Practices must engage in targeted advocacy to mitigate these disruptions, or risk a collapse in workforce capacity that will leave our most vulnerable patients without access to care.

Organization of Medical Association Presidents

Simultaneously, the Organization of Medical Association Presidents (OSMAP) convened to discuss a counter-offensive against the corporatization of healthcare economics. The discussion centered on the Multiplan Health Insurance Provider Litigation. This lawsuit alleges that major insurers colluded to artificially suppress payments for out-of-network services.

For Arizona physicians who have long battled opaque reimbursement structures, this litigation represents a rare opportunity to demand transparency and fair market restitution. ArMA has engaged Arnall, Golden, & Gregory LLC regarding potential inclusion as a litigant in this lawsuit. Stay tuned for more information. 

The Looming Threat: WISeR and the Algorithmization of Care

Perhaps the most critical development for Arizona physicians involves the new and controversial pilot program from the Centers for Medicare & Medicaid Services (CMS) known as the "Wasteful and Inappropriate Service Reduction" (WISeR) initiative.

Effective January 1, 2026, CMS introduced AI-driven prior authorization requirements for select outpatient Medicare procedures. Arizona is one of only six states selected for this pilot. The program targets categories such as skin and tissue substitutes and knee arthroscopy for degenerative joint disease.

The implications of WISeR are profound. We are witnessing the automation of denial. This model raises significant ethical and clinical concerns regarding the delay of critical care for older adults. By delegating medical necessity determinations to algorithms, CMS risks severing the patient-physician bond. The delegation’s stance is unequivocal: physicians electing not to submit prior authorization requests under this new regime will be subject to prepayment review. We must engage immediately to modify this program before it becomes an irreversible standard of care.

However, there is a counterbalance. Also taking effect on January 1, 2026, are new federal regulations mandating timeliness in processing prior authorization requests — 72 hours for urgent cases and seven calendar days for routine requests. This legislative victory provides a necessary check against the administrative friction that currently paralyzes practice operations.

The Administrative Burden: Confronting the "Prior Auth" Epidemic

The session on "Fixing Prior Authorization" revealed the staggering scale of administrative waste. Presenters underscored that prior authorization has metastasized from a cost-control mechanism into a barrier to care.

The AMA’s strategy is multifaceted, involving the deployment of tools like FixPriorAuth.org to aggregate data and support grassroots engagement. The House of Delegates (HOD) advanced policies to establish a national tracking system for authorization denials and advocated for "gold-carding" programs that exempt physicians with high approval rates from these onerous requirements.

Furthermore, Reference Committee J, which focused on insurer accountability, adopted vigorous new standards. The House voted to demand public reporting of denial rates and to investigate insurer financial gains derived from delayed care. In a significant move for clinical autonomy, the AMA will now advocate that low-cost medications and procedures should require no prior authorization whatsoever. This is a shift from defense to offense—demanding that the burden of proof lie with the insurer, not the clinician.

Protecting the Workforce: Scope, Visas, and Contracts

The integrity of the medical profession relies on maintaining rigorous standards of training. The Arizona delegation stood firm against the dilution of medical practice. So far this year, organized medicine has defeated more than 150 bills nationwide designed to inappropriately expand the scope of practice for non-physicians. The HOD adopted policies limiting laser surgery exclusively to MDs, DOs, or their equivalents, ensuring that complex surgical interventions remain in the hands of fully trained surgeons.

Yet, protecting the workforce also means ensuring we have a workforce. With one-fourth of U.S. physicians being International Medical Graduates (IMGs) or visa holders, the delegation opposed changes to the H-1B visa program that would impose exorbitant fees, up to $100,000 to sponsor a physician. For Arizona’s rural communities, which rely heavily on IMGs to fill critical gaps in primary care, such fees would be catastrophic. The delegation supported resolutions to increase transparency in residency programs for IMGs, recognizing that our ability to serve rural Arizona depends on a diverse and accessible talent pipeline.

Additionally, the changing landscape of employment was addressed. As consolidation forces more physicians into employed models, the AMA took a strong stance against restrictive covenants. The House directed the development of model legislation to prohibit "non-compete" clauses and indemnification requirements that force physicians to pay for tail insurance or assume liability for employer negligence.

Public Health and the Ethics of Innovation



Beyond the economics of practice, the meeting addressed the moral obligations of medicine. In the realm of public health, the delegation supported removing "red flag" designations for buprenorphine mono-products, ensuring that the treatment of opioid-use disorder is not stigmatized or bureaucratically obstructed.

Mental health also took center stage. Following the rescission of over $1 billion in federal mental health grants — a move that disproportionately harmed rural schools, the AMA resolved to advocate for sustained, automatic continuity protections for school-based mental health funding.

Finally, regarding the rapid integration of technology, the House adopted Reference Committee J’s policy on Artificial Intelligence. The consensus is that AI must be a tool for augmented intelligence, not a replacement for human judgment. New policies ensure that payer AI systems used for prior authorization are subject to physician oversight and strict transparency standards.

Conclusion: The Road Ahead

The proceedings of the Interim Meeting demonstrate that the threats to our profession are not static; they are evolving. From the AI-driven scrutiny of the WISeR pilot in Arizona to the courtroom battles against insurance giants, the landscape is shifting.

However, the actions taken by your delegation prove that we are not powerless. By leveraging the collective strength of the AMA and ArMA, we are rewriting the rules of engagement. We are moving from a position of resilience to one of resistance and reform.

The medicine of the future is being legislated today. Through our continued engagement, we ensure that those who control the legislation hear directly from those who hold the stethoscope.