PA 6 District Campaign-Series 1 Questions, Chrissy Houlahan & Marty Young

*Scroll Down For Series 2

Dear Colleagues:

        In an effort to help our local politicians understand the importance of health care in this election, the CCMS and UPG have developed a series of questions that we are sending to the politicians running for office in PA District 6.  These questions will be sent the beginning of the month and the candidate will be given a deadline to respond.  The answers from the candidates will be forwarded to CCMS /UPG members unreacted nor edited.  If a candidate does not respond then the "Candidate did not provide a response" will be noted. It is not the intention of CCMS/UPG to endorse one candidate over another but to ask each candidate a series of questions about healthcare and for you as members to contemplate their responses. We hope you find this helpful. Below please fine the answers to the first series of questions.

- Drew Murphy MD Chair of Advocacy

Chrissy Houlahan: We are a small campaign team and Chrissy is now in her fourth term with a very

established legislative record and continues to be present and accessible in the

community. We believe her actions speak volumes about the way she serves our

community and the values she leads with in Congress. Her voting record is available on

her official website, along with press releases, her social media accounts, and her

newsletters. With that in mind, we have made the decision to not participate in

questionnaires on any topic in this cycle.

Please access Chrissy’s priorities and accomplishments on her website: houlahan.house.gov

Marty Young: 1. How would you define the most significant structural challenges affecting physicians  today—both in delivering patient care and in sustaining the practice of medicine as a  profession and small business? 

The most significant structural changes are those that 1) artificially constrain the physician  workforce while 2) forcing providers to prioritize bureaucracy over patient care. These include: 

Workforce Constraints: 

• Artificial physician shortages created by outdated federal policy. The Balanced Budget Act  of 1997 capped Medicare-funded residency positions at 1996 levels. Despite our population  growing by more than 60 million people since then, the supply of new physicians has  remained frozen. This has produced severe shortages — especially in primary care — forcing  physicians to see more patients in less time, driving burnout, and limiting access in  communities like Chester County. This should be a priority for Congress to fix. 

• Soaring medical education costs and crushing student debt. The total cost of medical  school plus prerequisite college often exceeds $350,000. Many new physicians enter practice  carrying $200,000–$300,000+ in debt, which steers them away from primary care and  independent practice toward hospital employment simply to manage loan payments. In my  view this was primarily a result of the Grad PLUS loan program with uncapped borrowing  limits enacted by Congress in the Deficit Reduction Act of 2005, which greatly increased the  cost of attendance due to administrative costs and amenities.  

Although the BBB phases out the Grad PLUS program, universities and medical schools still  lack incentives to make a medical education affordable by attacking administrative bloat.  However, by focusing on loan and grant programs matched to the costs of the state colleges  and public universities, Congress could push the entire university system towards more affordable education overall.

Having graduated and served on the advisory board of the School of Industrial and Systems  Engineering at Georgia Tech (the #1 program in the world for 30+ years), I have seen how  the partnership model between federal programs, state universities and industry can yield  best-in-the-world education at affordable prices and lead the necessary reforms. 

• Unfair restrictions on physician-owned hospitals (POHs). While large healthcare insurers  like Kaiser Permanente can freely own and operate hospitals, federal policy severely restricts  physician-led facilities. POHs frequently deliver higher quality care at comparable or lower  costs. Yet Section 6001 of the Affordable Care Act (2010) amended the Stark Law to close  the “whole hospital exception,” grandfathering only pre-2010 facilities, banning new ones,  and freezing expansions. This inhibits the power of our free markets and ultimately costs  both doctors and patients by abdicating the medical profession from physicians to hospital  administrators and investors. 

Prioritizing Bureaucracy over Care 

• Crushing regulatory burdens are destroying private practice. Physicians now spend more  time on prior authorizations, EHR documentation, MIPS/MACRA reporting, and insurance  company bureaucracy than on direct patient care. These mandates, particularly those enacted  under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, Pub. L. 114- 10), have accelerated massive hospital consolidation — often justified by elusive economies  of scale — while making independent practice financially unsustainable. As a result, the  percentage of independent physicians has plummeted, reducing both physician autonomy and  patient choice.  

I am a strong proponent of expanding the transparency mechanisms already proven under  TRICARE, particularly its FOIA authorization processes (available to doctors and patients),  across all federal healthcare programs. By requiring Medicare, Medicaid, and other agencies  to adopt TRICARE’s standardized, accessible public disclosures and authorizations,  Congress could reduce administrative bloat, redundant regulations, and inefficient mandates  that drive up costs. Until then, the bureaucracy will continue to overwhelm the system. 

• The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which replaced  the Sustainable Growth Rate (SGR) with the overly complex Merit-based Incentive Payment  System (MIPS). This has imposed dozens of hours and thousands of dollars in annual  administrative costs per clinician, disproportionately harming small and independent  practices. It also added to administrative bloat across the system and ultimately increased the  costs of healthcare overall, while reducing accessibility and outcomes. 

A core driver of the structural changes is the government-aided, cost-plus business model of  large health insurance companies, where more bureaucracy results in more spending that then  increases revenues on a cost-plus basis and then profits as a percentage of revenues. 

2. Looking broadly at federal health policy over the past two decades, what do you believe  have been the most significant unintended consequences for patients, physicians, and the  health care system overall? Please include specific examples where possible.

• Physician burnout and the loss of the physician-patient relationship due to reduced  access to care and increased burnout. As healthcare went corporate, it has resulted in longer  wait times, overcrowded emergency rooms, and physicians seeing more patients in less time  — particularly harming primary care in suburban and rural areas like Chester County. 

• The rapid corporatization of medicine and destruction of independent private practice due to massive hospital consolidation, narrow insurance networks, and an explosion of  administrative burdens. As the percentage of physicians in independent practice has fallen  dramatically (from roughly 60% to under 30% in many specialties), patients face higher  premiums, larger deductibles, and more restricted networks. 

• The traditional local pediatrician has largely disappeared as independent pediatric  practices have been decimated by federal policies that increased administrative burdens and  favored large hospital systems. Children’s health has demonstrably worsened — the  prevalence of chronic conditions among 3- to 17-year-olds rose from 25.8% to 31% in the  general population and from 39.9% to 45.7% in pediatric health system data between 2011  and 2023, with sharp increases in obesity (from 17% in 2007–2008 to 21% in 2021–2023) and mental health issues. The result is reduced continuity of care, longer delays for children  with chronic conditions, and greater reliance on higher-cost hospital-based settings for  routine pediatric needs. 

• Hospitals have gone bankruptcy, including Jennersville and Brandywine here in  Chester County. These hospitals faced significant financial pressure from inadequate  reimbursement rates under Medicaid, Medicare, and private insurers, compounded by the  structural changes following the ACA and other policies. They were functioning prior to  these broader, structural shifts. 

• National health spending has risen steadily as a share of GDP — from ~13.3% in 2000 to  18.0% in 2024 — despite policies aimed at efficiency. This is unsustainable and now a major  driver of federal and state deficits that will ultimately drive perpetual inflation across the  economy.

PA 6 District Campaign-Series 2 Questions, Chrissy Houlahan & Marty Young

Chrissy Houlahan:

Chrissy Houlahan's voting record is available on her official website, along with press releases, her social media accounts, and her newsletters. With that in mind, her campaign team have made the decision to not participate in questionnaires on any topic in this cycle.

Please access Chrissy’s priorities and accomplishments on her website: houlahan.house.gov 

Marty Young:

1. How would you address the combined impact of declining reimbursement,

administrative burden, and increasing consolidation on the viability of independent

medical practice? Please identify specific federal policy changes you would prioritize.

The viability of independent medical practice faces a perfect storm: Medicare and Medicaid

reimbursements that frequently fail to cover the true cost of care (compounded by budget

neutrality constraints and inadequate annual updates), crushing administrative requirements that

pull physicians away from patients, and accelerating consolidation that hands large hospital

systems and insurers disproportionate negotiating power, narrows networks, and reduces patient

choice. Here in Chester County, these dynamics have contributed to the financial distress and

closures affecting facilities such as Jennersville and Brandywine hospitals—pressures that

ultimately harm independent physicians and limit access for our communities.

I would prioritize the following targeted federal policy changes:

a. Level the reimbursement playing field with site-neutral payments. Reform Medicare and

Medicaid so that the same clinical service receives comparable payment whether

delivered in a hospital outpatient department or an independent physician office or

ambulatory surgery center. Current site-of-service payment differentials actively

incentivize consolidation and systematically disadvantage independent practices. This

reform improves sustainability for physicians who choose to remain independent without

simply expanding overall federal spending. The easiest way to do this is to implement

TRICARE’s rates, rules and forms across all federally funded programs – It’s insane that

the same payer – the federal government – supports Medicare, Medicaid and TRICARE

with completely reimbursement rates and processes so let’s standardize on the best one!

b. Aggressively reduce administrative burden and prior authorization overreach. As I

proposed previously, expand TRICARE's proven transparency mechanisms-including its

FOIA authorization processes-to Medicare, Medicaid, and other federal healthcare

programs. This would reduce redundant regulations, administrative bloat, and inefficient

mandates. Additionally, for the private healthcare insurance companies, I support

leveraging TRICARE’s authorization forms for mandatory standardization of prior

authorization (electronic, real-time where feasible), "gold-carding" high-performing

independent physicians to exempt them from routine reviews, and enforceable time limits

on payer responses (i.e. TRICARE contractors must settle 98% of claims in 30 days and

100% in 90 days). Comprehensive medical liability reform, including reasonable caps on

non-economic damages, would further curb defensive medicine costs that function as

hidden administrative and premium burdens.

c. Restore competition by repealing harmful consolidation incentives. Repeal or

substantially reform Section 6001 of the Affordable Care Act (2010), which amended the

Stark Law to restrict new and expanding physician-owned hospitals – Physicians are not

Fraudsters which this change presumed! POHs have repeatedly demonstrated comparable

or superior quality at competitive costs; banning them abdicates medical leadership to

hospital administrators and investors. I would also strengthen antitrust enforcement and

review processes for hospital mergers and acquisitions of physician practices, and

advance PBM and 340B reforms to eliminate distortions that currently favor large,

consolidated entities over independent practices.

Together, these changes would directly counteract the combined pressures of declining

reimbursement, administrative overload, and consolidation—preserving patient choice and

creating conditions in which independent practices can thrive. A sustainable independent

delivery system is a prerequisite for the efficient, family-focused coverage expansion envisioned

in YAHP.

2. Current Medicare payment models, including MIPS and alternative payment models,

are widely viewed as administratively burdensome and of uncertain clinical value.

What specific reforms would you implement to improve clinical relevance and reduce

administrative complexity?

I fully share the view—articulated by physicians across specialties and reinforced in my prior

comments on MACRA—that MIPS and many alternative payment models (APMs) have

imposed dozens of hours and thousands of dollars in annual administrative costs per clinician

while delivering uncertain or marginal improvements in clinical outcomes. These programs have

disproportionately harmed small and independent practices and, in many cases, accelerated the

very consolidation they were meant to address.

I would implement the following concrete reforms:

a. Dramatically simplify and refocus MIPS. Reduce the measure set to a small core of

clinically meaningful, outcome-oriented metrics—such as avoidable hospitalizations,

patient-reported functional outcomes, and appropriate utilization of high-cost services—

rather than process-heavy or checkbox measures with weak links to patient benefit.

Automate data extraction directly from certified EHRs to eliminate most manual

reporting. For small and independent practices, create a streamlined “MIPS Express”

pathway or size-based exemption threshold, replacing punitive payment adjustments with

positive incentives, technical assistance grants, and collaborative learning networks. The

goal is relevance to actual clinical work, not compliance theater.

b. Reform and right-size Alternative Payment Models. Make meaningful participation truly

voluntary, with risk adjustment robust enough to protect practices serving medically

complex or socioeconomically disadvantaged populations. Prioritize simpler, lower-

administrative-burden models—such as primary care capitation or well-designed episode

bundles for common procedures—that have demonstrated clear value in independent

evaluations. Sunset or substantially reform APMs whose implementation costs outweigh

measurable clinical or financial gains. Critically, align quality measures and reporting

requirements across Medicare, Medicaid, and commercial payers so that one set of

clinically relevant data satisfies multiple programs, ending the current multiplication of

administrative effort.

c. Import proven efficiencies from TRICARE. TRICARE has achieved care coordination

and accountability with significantly lower administrative overhead than traditional

Medicare or commercial models. I would direct CMS and other agencies to adopt and

adapt TRICARE’s streamlined approaches to quality measurement, authorization, and

transparency—reducing complexity while preserving or improving accountability for

outcomes.

3. Efforts to align incentives through value-based care have produced mixed results. How

would you redesign or realign financial and clinical incentives across payers, providers,

and patients to improve outcomes without undermining practice sustainability?

At its core, the concept of value-based care is designed to obviate the age-old physician-patient

relationship with a big healthcare solution. This is why value-based care has produced genuinely

mixed results. Large integrated delivery systems with sophisticated data infrastructure and care

management teams have often captured and taken advantage of both economies and

diseconomies of scale, while independent practices, where the authentic doctor-patient

relationships live, have faced high barriers to entry, leading to further consolidation. Some

models have created incentives for stinting or inadequate risk adjustment; no wonder

administrative complexity has frequently exceeded the value delivered; and patient engagement

has remained limited due to lack of personal relationship with his or her physician. The net effect

in many communities has been reduced choice and sustainability challenges for the very

practices that provide most primary and specialty care.

I would redesign incentives around three core principles—patient empowerment, provider

sustainability (especially for independents), and payer accountability—while anchoring broader

reforms in the efficient, transparent model that underpins YAHP:

a. Empower patients with real skin in the game and transparency. Accelerate and enforce

robust price transparency requirements so patients and referring physicians can see actual

costs. Expand Health Savings Accounts with higher contribution limits and incentives for

preventive care and healthy behaviors. Support Direct Primary Care (DPC) arrangements

that allow patients and physicians to contract directly for routine care, bypassing layers of

insurance administration. These steps align patient incentives with value and reduce

unnecessary utilization without top-down rationing. In particular, I like the MDVIP

business model as commercially sensible solution to restoring the physician-patient

relationship, especially when paired with TRICARE or a reimagined healthcare coverage

system that standardizes on TRICARE rates, rules and forms.

b. Eliminate government provider incentives which only advantage larger provider

networks and provide a standardized reimbursement rate that sustains independent

practices – in other words, move all the federal programs (Medicaid, Medicare, Federal

Employees, etc.) to the TRICARE rates. Ensure that base payments—whether fee-for-

service or capitation—are adequate to cover the cost of high-quality care plus a

sustainable operating margin. Provide targeted infrastructure support (data analytics

partnerships, care coordination resources) without conditioning it on employment by a

hospital system. This prevents the “race to the bottom” that currently undermines practice

viability. Again, I like the MDVIP business model as commercially sensible solution to

obviating “provider incentives” altogether, especially when paired with TRICARE or a

reimagined healthcare coverage system that standardizes on TRICARE rates, rules and

forms.

c. Increase payer accountability and reduce middleman distortions. Advance comprehensive

PBM reform—requiring pass-through pricing, banning spread pricing, and increasing

transparency of rebates and fees—so that savings accrue to patients and providers rather

than intermediaries. Apply similar transparency and accountability standards to 340B

program participants. Promote genuine competition among health plans. Standardize a

parsimonious, clinically relevant core measure set that all payers (public and private) are

encouraged or required to adopt, eliminating duplicative and conflicting reporting

demands.

d. Anchor reforms in the YAHP/TRICARE efficiency model. My Young Americans

Healthcare Plan would first stabilize and strengthen the independent delivery system

through the reforms outlined above, then efficiently extend TRICARE-modeled

coverage—known for low administrative overhead, strong coordination, and proven cost

discipline—to children, young adults up to age 23, and expectant mothers... then

eventually to the entire adult population up to age 65. By demonstrating that high-quality,

affordable coverage for families is achievable without exploding costs or forcing

consolidation, YAHP would serve as both a direct solution for working families and a

proof-of-concept for broader, sustainable realignment of incentives across the entire

system.

In summary, my approach applies the same turnaround discipline I have used throughout my

career—eliminating waste and administrative bloat, aligning incentives with real value,

increasing transparency and competition, and investing in the workforce—to restore

sustainability and excellence to American healthcare. These changes would put patients and

physicians first, preserve the independent practice model that has served Chester County so well,

and create the conditions for YAHP to deliver on its promise of affordable, high-quality

coverage for the next generation of American families.