2026 Signature Series Congressional Briefing

September 1, 2026

12:00 pm-

1:30 pm

In Person Event

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
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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
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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
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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
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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
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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

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Experts

Loren Adler, M.S.

Fellow and Associate Director, USC-Brookings Schaeffer Initiative for Health Policy
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Loren Adler is a fellow and associate director at the Center on Health Policy. He is currently a member of the Advisory Committee on Ground Ambulance and Patient Billing, established by the No Surprises Act, and serves as an associate editor of the Health Affairs Scholar journal. His research focuses on a range of topics in health care economics and policy, including private equity and payer acquisitions of physician practices, provider consolidation, surprise billing, Medicare Advantage, and prescription drug pricing. Previously, Mr. Adler served as research director for the Committee for a Responsible Federal Budget and as a senior policy analyst for the Bipartisan Policy Center. Adler received his bachelor’s degree in mathematical economics from Wesleyan University and his M.S. in applied economics from Johns Hopkins University.

Joe Albanese, MPP

Director of Policy, Center for Medicare
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Joe Albanese is the Director of Policy at the Center for Medicare. Joe was previously a Senior Policy Analyst at Paragon Health Institute where his work included numerous published reports and congressional testimonies pertaining to Medicare. Prior to that, he was a Program Examiner on the Medicare team at the White House Office of Management and Budget. Joe holds a Bachelor of Science and Master in Public Policy from Georgetown University.

Joseph Antos, Ph.D.

Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute
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Joseph Antos is Senior Fellow Emeritus at the American Enterprise Institute (AEI). His work focuses on the economics of health policy, including Medicare, the Affordable Care Act, private insurance, and overall reform of the health care system. He is an adjunct associate professor of emergency medicine at the George Washington University, and recently completed four terms on the Maryland Health Services Cost Review Commission.

Before joining AEI, Antos was assistant director for health and human resources at the Congressional Budget Office. He also held senior positions in the US Department of Health and Human Services, the Office of Management and Budget, and the President’s Council of Economic Advisers.

Antos has been published in academic journals and the popular press, including Health Affairs, the Journal of the American Medical Association, the New England Journal of Medicine, the New York Times, and the Wall Street Journal. He has a Ph.D. in economics from the University of Rochester.

Alec Aramanda

Principal Deputy Director, Center for Medicare
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Alec Aramanda serves as the Principal Deputy Director of the Center for Medicare, overseeing policy and operations related to Medicare fee-for-service, Medicare Advantage, and the Medicare Prescription Drug Program. Prior to joining the Center for Medicare, Alec worked at the U.S. House Energy and Commerce Committee where he led the Medicare and Health Information Technology portfolio. He previously served at CMS from 2018 through 2021 as the Director of the Office of Legislation and the Director of Stakeholder Engagement. Before joining CMS in 2018 he served as the Deputy Assistant Secretary for Health Policy in the Office of the Assistant Secretary for Legislation at the Department of Health and Human Services from 2017 through 2018. He began his public policy career at the Heritage Foundation in 2006 before serving in the U.S. Senate from 2010 through 2017 in the offices of Senators Jim DeMint and Ted Cruz. Before re-joining CMS in February of 2025, he most recently worked at law firm Williams & Jensen. He received a B.A. in Political Science from Haverford College.

Robert Berenson, MD

Institute Fellow, Urban Institute

Matthew Fiedler, PhD

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

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

Paul B. Ginsburg, PhD

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

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

Benedic Ippolito, PhD

Senior Fellow, American Enterprise Institute; Member, MedPAC

Doug Jacobs, MD, MPH

Executive Director, Maryland Health Care Commission

Ashish Jha, MD, MPH

Co-Founder & CEO, BioRadar

Mark McClellan, MD, PhD

Director, Duke-Margolis Institute for Health Policy

Mara McDermott, J.D.

Chief Executive Officer and Founder, Accountable for Health
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Mara McDermott is the Chief Executive Officer of Accountable for Health, a Washington D.C.-based advocacy organization committed to accelerating the adoption of effective accountable care. She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models.

Hannah Neprash, Ph.D.

Associate Professor of Health Policy and Management, University of Minnesota School of Public Health

James “JP” Paluskiewicz

Senior Policy Advisor, Alston & Bird
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James “JP” Paluskiewicz is a senior policy advisor in the Health Care group. JP advises health care clients on legislative and public policy matters before Congress, the Administration, and other government agencies. JP devises strategies for effective outreach and messaging to assist health care clients in navigating complex legislation and regulation. He develops and executes legislative and regulatory solutions on behalf of health care provider groups, health care systems, hospitals, biopharmaceutical and medical device companies, and health payers while working directly with policymakers on the Hill and in the Administration to secure their passage and implementation.

JP was chief counsel on the House Energy and Commerce Committee, Health Subcommittee and oversaw all policy matters under the committee’s jurisdiction, including legislation affecting the Food and Drug Administration, Medicare, Medicaid, private insurance, health information technology, and public health. He managed the committee’s health agenda, policy development, and legislative strategy for Republicans. He was also the sole policy staffer overseeing Medicare Parts B and D and health information technology. During his tenure on Capitol Hill, JP developed and shepherded numerous policies throughout the legislative process.

JP is an adjunct professor at The George Washington University’s Graduate School of Political Management and Milken Institute School of Public Health. JP regularly serves as a panelist and speaker on policy matters to health care audiences throughout the Washington, D.C. area.

Event Series

Health Care Payment

Signature Series 2026

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.