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

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• Artificial physician shortages created by outdated federal policy.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.