Family Medicine Advocacy Rounds, March 2026

AAFP CEO testifies before Congress on U.S. health care affordability 

For decades, the U.S. has woefully underinvested in primary care, and patients are paying the price. On Wednesday, March 18, AAFP's EVP and CEO R. Shawn Martin testified before the House Energy and Commerce Subcommittee on Health for a hearing on the role that clinicians play in making health care more affordable for all Americans. Martin laid out his message to the subcommittee in a blog post entiled "Six ways Congress can make health care affordable for doctors and patients."

Chronic diseases now account for 90% of our $4.9 trillion in annual health care spending. Yet, the U.S. allocates less than 5% of total health expenditures to primary care, a figure that lags far behind other developed nations. Primary care receives a small fraction of overall health care spending, even as it is asked to do more to manage chronic disease, coordinate care, and serve as the front door to the health system. This chronic underinvestment has led to workforce shortages, longer wait times, practice closures and fragmented care that drives costs higher for everyone. It also accelerates health care consolidation, which often makes profit an incentive rather than patient care.

AAFP takes family medicine priorities to Capitol Hill

Last month, AAFP leaders convened on Capitol Hill to push for practical solutions that will improve access to care for patients and improve practice environments for physicians. They engaged directly with lawmakers and urged them to enact policies that would do the following.

• Make primary care more affordable. Ongoing, coordinated care keeps patients healthier, but only if cost-sharing doesn’t stand in the way. When patients worry about surprise charges, they skip essential follow-up and coordination services. That hurts outcomes and raises long-term costs. Primary care must be affordable for it to work.
• Protect access to vaccines. Family physicians are among the most trusted sources for vaccine guidance and delivery. Public policy must continue to be grounded in science and data.
• Enact tax policies that strengthen independent practice and the primary care workforce. Targeted incentives can help support physicians serving rural and underserved communities, care for vulnerable populations and promote practice ownership. Several states have explored or implemented approaches such as these. Together, these incentives can help recruit, retain and sustain primary care where it’s needed most.

Department of Education rule would jeopardize primary care workforce

Why it matters: 

Physicians are the most likely professionals to carry student loan debt, with 81% having graduate school debt and 80% owing due to undergraduate education. 

The high burden of medical education debt contributes to worsening physician shortages and puts medical education out of reach for many potential physicians, further undermining progress toward a robust health care workforce. Given that these challenges slow progress toward better patient and population health outcomes, addressing the burden of student loan debt for physicians and medical students is one essential step to improving our nation’s health care system.

What we’re working on: 

AAFP submitted a letter to the U.S. Department of Education urging the agency to expand individuals’ ability to pursue a career in family medicine, including through thoughtful regulation of federal student loan programs. Our letter asked that the department:

• maintain access to Graduate PLUS loans for medical students or create a medical education carve‑out in the new loan programs to reflect the unique cost structure, training length and public service value of primary care physicians;
• exempt medical education programs from automatic loan proration or provide clear hardship and program‑specific exceptions to ensure that future primary care physicians are not forced into private lending or delaying completion of their education; and
• preserve generous reconsideration and correction mechanisms and ensure that repayment plan transitions do not reset or jeopardize Public Service Loan Forgiveness program eligibility.

AAFP also submitted a letter to Congress expressing concern that many of the higher education reforms in H.R. 1, including a $200,000 cap on professional student loans, will lead to even fewer new primary care physicians.

• In our letter, we called for passage of the REDI Act to mitigate at least a small portion of the financial burden that family physicians and others accrue while they are completing their medical training.

Family physicians weigh in on AI adoption in clinical care

Why it matters: 

The family medicine experience is based on a deeply personal patient-physician relationship that benefits from many supportive technologies, including AI. 

In 2023, the AAFP developed an initial set of principles that we believe must be applied to AI’s implementation across the broad range of settings in which family physicians practice. 

AAFP believes AI tools should be evaluated with the same rigor as any other tool used in health care, and that it has the potential to support the core functions of primary care, which are frequently characterized as first contact, comprehensiveness, continuity and coordination of care.

What we’re working on: 

AAFP submitted comments and joined a sign-on letter to the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC) and recommended ways to establish a stronger approach to use AI as part of clinical care. In our letter, the AAFP highlighted the following.

• AI technologies and medical devices must be integrated into health care in ways that are safe, effective, fair and transparent.
• HHS should include practicing physicians throughout the AI lifecycle and establish advisory panels that include primary care physicians to ensure AI tools are aligned with real-world clinical workflows and patient needs. An AAFP survey conducted jointly with Rock Health in September 2024 found that many primary care physicians reported having little to no involvement in these decision‑making processes. This can lead to AI tools being implemented that impede, rather than improve, clinical workflows.
• AAFP strongly believes that AI tools should enhance, not burden, clinical practice. We support HHS prioritizing research on AI products that streamline documentation, reduce administrative burden and support clinical decision-making.
• AAFP recommends modernizing payment policies so practices, especially small and independent practices, can invest in the infrastructure needed for AI integration.

Also in the health IT arena, the AAFP submitted comments to ASTP/ONC and urged the agency to maintain key privacy, security and transparency requirements in the Health IT Certification Program and ensure that the health care system maintains a robust health IT landscape while reducing administrative burden and spurring innovation.

On the legislative side, the AAFP submitted a letter for the record ahead of a Senate Committee on Health, Education, Labor and Pensions hearing with Dr. Thomas Keane, Assistant Secretary for Technology Policy and National Coordinator for Health Information Technology. In the letter, the Academy outlined how the committee can support the recommendations the AAFP shared with ASTP/ONC in its two recent comment letters.

AAFP urges Congress to support health care research 

Why it matters: 

Too many Americans struggle to get the care they need. Patients face long wait times, high costs and care that doesn’t always improve their health. At the same time, many physicians are burned out. Health services research helps find practical solutions to these problems. But when funding is cut, it becomes harder for our country to improve care and health outcomes.

What we’re working on:

• AAFP signed onto a letter to Congress asking lawmakers to fully fund the Agency for Healthcare Research and Quality in the next fiscal year.
• AHRQ provides research and data that help doctors, patients and policymakers make smarter health care decisions. Its work helps ensure that people get high-quality care at a reasonable cost.
• We urged Congress to provide at least $500 million for AHRQ so it can continue research that makes care safer and more affordable.
• We also asked HHS to support adequate staffing and resources so AHRQ can effectively manage its programs, research grants and scientific review process.

What we're reading

The voice of a physician has always carried weight, especially when it comes to advocacy for public policies. In a new First Opinion essay in STAT, AAFP President Sarah C. Nosal, MD, writes that it’s more important than ever for doctors to leverage their authority to push for a variety of changes that shape care both inside and beyond the exam room.

AAFP Board Chair Jen Brull, MD, spoke to Healio about how a proposed rule would cap graduate student loan borrowing. 

AAFP’s Robert Graham Center’s new thematic report on chronic disease was covered in Marketplace. The report explores how primary care plays a vital role in in the prevention, early detection and management of chronic disease while helping reduce the financial burden on both the U.S. health care system and its patients.

For the latest policy updates impacting family medicine, follow us at @aafp_advocacy.