2026 Signature Series Congressional Briefing

September 1, 2026

12:00 pm-

1:30 pm

MACRA: Perspectives on What Worked in the 2015 Reform, What’s Missing, and Why It Matters Today

The Medicare Access and CHIP Reauthorization Act (MACRA) was enacted in 2015, repealing the Sustainable Growth Rate formula and establishing a new framework for Medicare physician payment. As Congress revisits the Medicare Physician Fee Schedule and MACRA’s value-based incentives, this briefing will consider the law’s original objectives, its implementation, and how the physician payment landscape has evolved since its passage.

As the final event in the Alliance’s Signature Series on Health Care Payment, the briefing examined MACRA as a case study in bipartisan payment reform. Expert panelists traced the major milestones that shaped Medicare physician payment, explained how rates are set, and explored what MACRA changed. At the heart of the program, former congressional staff who helped develop and implement the law took attendees inside “the room where it happened” to discuss what Congress sought to accomplish, what happened after implementation, and what they have learned since. Drawing on recent data and analysis, including findings from MedPAC, the program also examined where physician payment stands today.

Together, these perspectives provided congressional staff and the broader public with historical context and a framework for understanding ongoing Medicare physician payment discussions.

By the end of this briefing, attendees were able to:

Trace the history of Medicare physician payment and the changes established by MACRA.
Identify MACRA’s original policy goals and the trade-offs made during negotiations.
Understand how Medicare physician payment rates are determined, including the roles of relative value units, the conversion factor, budget neutrality, and the Relative Value Scale Update Committee (RUC).
Review recent physician payment data and trends and identify considerations relevant to ongoing congressional deliberations.

Speakers

Michael Baker, MS, MA, Director, Health Care Policy, American Action Forum (moderator)
Brett Baker, Partner, The Nickles Group
Michael Chernew, Ph.D., Leonard D. Schaeffer Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School; Director, Healthcare Markets and Regulation Lab, Harvard Medical School
Elizabeth Jurinka, M.A., Operating Director, Healthcare Policy, The Vistria Group, PRG
Kristen O’Brien, JD, Partner, Holland & Knight

This widely attended educational event was free and open to the public. The Alliance gratefully acknowledges the sponsors of the Signature Series on Health Care Payment, whose support makes this educational programming possible. View the complete list of Signature Series sponsors.

Speakers

Michael Baker, M.S., M.A.

Director, Health Care Policy, American Action Forum

Michael leads AAF’s health care research and analysis portfolio, including prescription drug pricing policy, Medicare and Medicaid payment rules, the Food and Drug Administration, and employer-sponsored insurance markets. His research and analysis have appeared in numerous publications. Prior to joining AAF, Michael worked in both the public and private sectors on a broad array of health and human services policy. He has provided in-house and multi-client health policy leadership in the private sector, including on policy development, regulatory affairs, and strategic capital planning, for hospitals, payers, investment firms, and other stakeholders. Michael also worked at the Department of Health and Human Services on issues related to drug pricing and pharmaceutical manufacturing, public health, competition and transparency, and innovation policy. His purview has also included health IT interoperability and data exchange, HIPAA, and public health informatics. Michael holds a master’s degree in biohazardous threat agents and emerging infectious diseases from Georgetown University, a master’s degree in economics from American University, and a bachelor’s degree in biology from the University of Toledo.

Brett Baker

Partner, The Nickles Group

Brett Baker is a Partner at The Nickles Group. His extensive legislative and policy experience have earned him the respect and trust of policymakers across the political spectrum that helps clients achieve their goals. He spent over a decade on Capitol Hill working on many of the significant Medicare bills that passed Congress during that time. He has shaped health care policies that have touched every sector of the health care industry. Brett was integral in the development of legislation that provided relief to physicians from Medicare Sustainable Growth Rate (SGR) formula payment reductions, including the transformative Medicare Access and CHIP Reauthorization Act (MACRA) enacted in 2015. He also played a leading role in shaping the prescription pricing policy debate and COVID-19 relief laws enacted during the first year of the pandemic. Brett worked for the Senate Finance Committee where he held key health staff positions under Chairman Orrin Hatch (R-UT), Chairman Chuck Grassley (R-IA), and Ranking Member Mike Crapo (R-ID). Prior to his service in the Senate, Brett was a professional staff member for the House Ways and Means Committee under Chairman Dave Camp (R-MI) and Paul Ryan (R-WI), where he focused on physician payment policy and other Medicare Part B issues. Brett began his career at the American College of Physicians in Washington, D.C. He has a Bachelor of Science degree from the Pennsylvania State University.

Elizabeth Jurinka, M.A.

Operating Director, Healthcare Policy, The Vistria Group; Senior Policy Fellow, Yale Tobin Center

Prior to entering the private sector, Elizabeth spent nearly two decades in the White House and Congress, specializing in health care policy and strategy. Most recently, Elizabeth served in the White House as a Special Assistant to the President in the Office of Legislative Affairs where she worked with her colleagues to successfully promote and pass The American Rescue Plan (ARP), The Infrastructure Investment and Jobs Act (IIJA), and The Inflation Reduction Act (IRA). Prior to the White House, she served as Chief Health Advisor to Chairman Ron Wyden (D OR) and the Senate Finance Committee where she oversaw the development and execution of key health care priorities within the Committee’s extensive health care jurisdiction of Medicare, Medicaid, and key components of the Affordable Care Act. In this role, Elizabeth was instrumental in developing the arguments and strategy used to successfully prevent repeal of the Affordable Care Act and spearheaded negotiations with the Committee Republicans on prescription drug pricing reform that later became the basis for policies passed in the Inflation Reduction Act. During her tenure on Capitol Hill, she also negotiated several other major health care bills including the repeal of the Sustainable Growth Rate, the longest CHIP extension since the program’s enactment, and chronic care reform, among others. Elizabeth is also a Senior Policy Fellow at Yale University’s Tobin Center for Economic Policy. Elizabeth received her B.A. from the University of Maryland and her M.A. in Government from Johns Hopkins University.

Michael Chernew, Ph.D.

Leonard D. Schaeffer Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School; Director, Healthcare Markets and Regulation Lab, Harvard Medical School

Michael Chernew, PhD, is the Leonard D. Schaeffer Professor of Health Care Policy and Director of the Healthcare Markets and Regulation Lab at Harvard Medical School. His research focuses on improving the healthcare system through improvements to benefit designs, payment models, and regulation of both private and public health care markets, including the Medicare Advantage program. Michael served as Chair of the Medicare Payment Advisory Commission (MedPAC) and vice chair of the Massachusetts Health Connector Board. He has served on several advisory panels for CMS and is a member of the Congressional Budget Office’s Panel of Health Advisors. Michael holds a PhD in economics from Stanford University and has received multiple awards for his work in healthcare policy.

Kristen O’Brien, J.D.

Partner, Holland & Knight

Kristen's work focuses on implementing new laws through the rulemaking process, as well as working with relevant agency officials to develop and improve agency guidance. Kristen recently served as Principal of the Health Industry Policy and Regulatory Practice Group at a law and lobbying firm where she provided representation for hospital systems, physician practices, medical device companies, digital health companies and trade associations. She has extensive experience in providing analysis and counsel related to government healthcare payment programs under Medicare and Medicaid. She also has extensive knowledge of navigating the Centers for Medicare & Medicaid Services (CMS), the Office of the National Coordinator for Health Information Technology (ONC) and others. Previously, Kristen provided legislative and regulatory legal analysis as a senior attorney for the American Medical Association.

Presentation: 2026 Signature Series on Health Care Payment: Congressional Briefing Slide Deck

Download

Event Resources

Key Resources

“Rethinking the Role of Pay for Performance in Federal Health Care Quality Programs.” Chernew, M., Schneider, E. C. New England Journal of Medicine. August 8, 2026.

“MACRA: A Mixed Record for Medicare Physician Payment Reform.” Baker, M. American Action Forum. June 24, 2026.

“Improving Payment Incentives in Medicare” (Ch. 1, Report to the Congress: Medicare and the Health Care Delivery System). Medicare Payment Advisory Commission (MedPAC). June 15, 2026.

“What to Know About How Medicare Pays Physicians.” Cottrill, A., Cubanski, J., Neuman, T. KFF. October 7, 2025.

“Trends in Physician Exit From Fee-for-Service Medicare.” Neprash, H., Chernew, M. JAMA Health Forum. July 18, 2025.

“MACRA: Medicare's Fitful Quest for Value-Based Care.” Albanese, J. Paragon Health Institute. May 2023.

“Implementing MACRA.” Findlay, S. Health Affairs. March 27, 2017.

Experts

Loren Adler, M.S.

Fellow and Associate Director, USC-Brookings Schaeffer Initiative for Health Policy

Joseph Antos, Ph.D.

Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute

Robert Berenson, MD

Institute Fellow, Urban Institute

Matthew Fiedler, PhD

Joseph A. Pechman Senior Fellow, USC-Brookings Schaeffer Initiative for Health Policy

Benedic Ippolito, PhD

Senior Fellow, American Enterprise Institute; Member, MedPAC

Joe Albanese, MPP

Director of Policy, Center for Medicare

Alec Aramanda

Principal Deputy Director, Center for Medicare

Mark McClellan, MD, PhD

Director, Duke-Margolis Institute for Health Policy

Paul B. Ginsburg, PhD

Emeritus Fellow, USC-Brookings Schaeffer Initiative for Health Policy; Founding Director, Physician Payment Review Commission

James “JP” Paluskiewicz

Senior Policy Advisor, Alston & Bird

Mara McDermott, J.D.

Chief Executive Officer and Founder, Accountable for Health

Erin Richardson, J.D., M.A.

Senior Vice President, Policy & Regulatory Affairs, Kaiser Foundation Health Plan, Inc.

Jake Quinton, MD, MS, MPH

Chief Medical Officer, Parts A/B, Center for Medicare, Centers for Medicare & Medicaid Services

Karen Fisher

Retired Chief Public Policy Officer, Association of American Medical Colleges (AAMC)

Anders Gilberg, MGA

Senior Vice President, Government Affairs, Medical Group Management Association (MGMA)

Geoffrey Gerhardt

Principal Policy Analyst, MedPAC

Tim Gronniger, MPP

CEO, Hopscotch Primary Care

Amy Hall

Staff Director, Subcommittee on Health, Ways and Means Committee

Jackson Hammond

Senior Policy Analyst, Paragon Health Institute

Doug Jacobs, MD, MPH

Executive Director, Maryland Health Care Commission

Event Series

This event is part of the

Signature Series 2026

series.

Signature Series 2026

Health Care Payment

In 2026, the Alliance for Health Policy will mark the 10th year of its flagship annual Signature Series by examining one of the most foundational and least understood drivers of the health care system: how health care is paid for.

Learn More about the Series

Back to All Events