For many years, the Post-Acute and Long-Term Care Medical Association (PALTmed) has sent a contingent of leaders (officers and board members) to Washington, D.C. for Capitol Hill visits every autumn.  This year for the first time, our advocacy efforts were opened up to the general membership, and over 50 PALTmed members, representing constituents of 25 states and the District of Columbia, attended the first annual PALTmed Advocacy Summit on October 27-28, 2025.

The Summit kicked off with a morning of educational and strategic sessions, featuring PALTmed’s policy staffers Alex Bardakh (a CALTCM annual meeting favorite) and Gaby Geise, along with PALTmed’s lobbyist, Sue Emmer.  Guest presenters from multiple Congressional offices also presented, including Ali Feinswog from the office of my Congressman, Mike Levin (D-CA-49).  

Despite the fact that the government shutdown was in full force on those dates, 81 meetings in Congressional offices went forward on those days—45 on the Senate side and 36 on the House side.  California was represented by Dr. Mike Wasserman and me, and we visited Senators Padilla and Schiff’s offices together.  We also visited some other Representatives’ offices and committee offices.  Because of the shutdown, many of the actual legislators were not present in the offices, so attendees met with health and policy staffers in most instances.  In my experience attending these Hill visits over many years, I’ve found these staffers to be young and very bright, with a surprising amount of knowledge and insight into our issues.

The specific issues that Advocacy Summit attendees were tasked to address with the Congressional offices were determined by the PALTmed Board and Public Policy Committee.  These talking points or “asks” were as follows:

• Support the CONNECT for Health Act of 2025 (H.R. 1261 / S. 4206), sponsored by Sens. Brian Schatz (D-HI) and Mike Thompson (D-CA-04), which would permanently remove geographic and originating site restrictions, allow patients to receive care from home or wherever they reside, keep FQHCs and RHCs eligible as distant-site providers, continue coverage for audio-only telehealth, maintain the expanded provider list, and encourage data collection/guard against fraud and abuse. Also, if the CONNECT Act cannot pass this session, we asked legislators to extend telehealth flexibilities in any end-of-year Congressional package. [The latter actually did occur; the legislation has not moved.]
• Workforce/geriatric clinician shortage (including physicians and non-physicians): has the potential to limit access to care for millions of post-acute and long-term care (PALTC) residents.  The supply of geriatricians, already critically short, is projected to decline while the number of patients over 65 is set to increase markedly over the next 10-20 years. In addition to requesting efforts to collect accurate data on workforce statistics and their impact on PALTC, we asked legislators’ support to strengthen Title VII Geriatrics Programs, including Geriatrics Workforce Enhancement Programs (GWEPs) and Geriatrics Academic Career Awards (GACAs).  Finally, we urged legislators to co-sponsor H.R. 4262 / S. 2699 (Senators. Collins, D-ME and Schakowsky, D-IL-09) to reauthorize these programs at $48.2M (FY 2026–2030).
• Medicare Payment Reform: Update payments: Tie Medicare rates to real-world cost drivers like the Medicare economic index (MEI) to reflect cost and complexity of providing quality care in PALTC. Previous bipartisan legislation supported this concept, such as the  Strengthening Medicare for Patients and Providers Act (H.R. 2474) in the 118th Congress as one such historical example. MedPAC (a policy advisory arm to Congress) has supported this solution.  Stop arbitrary cuts, and instead reform budget neutrality rules to protect clinicians and ensure payment stability.  And finally, cut paperwork: Simplify MIPS and other programs so clinicians can focus on patient care. Include reform in year-end legislation, attempting to ensure provider stability, promote value-based care, and align payments with service complexity.

For me, the highlight of our Hill visits was actually the day after the Advocacy Summit ended.  I had met with staff in my Congressman’s office on Tuesday, October 28, but he was not in town that day (he was back in our district, since the shutdown was in effect).  I was surprised that evening to get an email from Rep. Levin’s office asking me if I was still going to be in town the next morning, and if so, would I like to meet with the Congressman then?  Luckily, my flight wasn’t until 5 pm, so I enthusiastically agreed to go back to his office.

After meeting with Rep. Levin and Ali in his office in the Rayburn building the next morning, he asked me if I would like to tag along while he gave some media interviews.  We then went down to the basement and took a very retro tunnel tram from his building to the Capitol, where six media outlets had reporters and video setups, and where Members of Congress rotated through, giving brief interviews.  Mr. Levin introduced me to several of his colleagues, including Rep. Jamie Raskin (D-MD-8)—and told them I was essentially a frontline hero from his district who cared for vulnerable elders in nursing homes, and helped him during the pandemic by sharing information via his virtual Town Hall meetings.  It was quite an experience, and I have to say it will be hard for future Hill visits to beat this PALTmed Advocacy Summit!

These are very troubling times in the federal government, as even people like me who try to avoid watching the news have to be aware.  Yet it’s vitally important for us to communicate with our legislators, advocate for the patients we look after, and stand up for what is right.  Medicaid cuts, attacks on science, public health and vaccines, and creating further obstacles to training and research have the potential to set us back by decades.  I urge all readers to take the time to get to know someone in their state and federal legislators’ offices—maybe even offer to serve as a resource when other constituents have issues that we are experts on.  We may not be able to singlehandedly change things, but these efforts can really pay off—such as when Rep. Levin and a Republican colleague, Brian Fitzpatrick (R-PA-1) introduced legislation to require CMS to publicly disclose the identity of all skilled nursing facility medical directors, prompting CMS to finally make the long-requested regulatory changes without requiring a literal Act of Congress.

As we try to navigate the turbulent waters ahead, it is wise to work with our legislators and regulatory agencies to help ensure that science, reason and compassion remain at the table.  I urge all of our WAVE readers to make a commitment to forging a relationship with at least one of their legislators in 2026!  CALTCM has many leaders and members with experience who can help.  And we’d love to have you on our Policy & Professional Services Committee.  If you’re interested, please contact Barbara Hulz ([email protected]).

And next October, Dr. Wasserman and I hope our California contingent to the PALTmed Advocacy Summit in DC will be able to welcome more CALTCM members and WAVE readers to join our Capitol Hill visits!