Advocacy is Medicine

This podcast is FULL of the background on the physician fee payment structure and how HR1 is immediately impacting this year. Dr. Fox is a long time advocate with great insight into how to bring about meaningful change moving forward.

Revaluing Physician Services: CMS Has Some (but Not All) Answers | Annals of Internal Medicine

William Fox. Revaluing Physician Services: CMS Has Some (but Not All) Answers. Ann Intern Med.2026;179:127-128. [Epub 4 November 2025]. doi:10.7326/ANNALS-25-03638

Schafer J, Vogel M, Grell T, Paez M, Parker A. 2023 Status of the Nebraska Healthcare Workforce. University of Nebraska Medical Center; 2023:70. https://www.unmc.edu/rural-health/_documents/healthcare-workforce-2024.pdf#2023%20Report

Key Findings on Primary Care Deserts (2023-2024 Data):

• County-Level Shortages: In 2023, 21 of Nebraska's 93 counties lacked a primary care physician.

• Maternity Care Deserts: Over 50% of Nebraska counties are considered maternity care deserts, lacking access to OB/GYN care or birth centers, which is significantly higher than the national average of 32.6%.

• Geographic Concentration: Approximately 83% of all diagnosing and treating practitioners in Nebraska are concentrated in metropolitan areas (Omaha/Lincoln), leaving rural areas underserved.

• Aging Workforce: A significant portion of the workforce is nearing retirement, with 19.4% of physicians in Nebraska being 61 or older, increasing the risk of further shortages in the next 5-10 years.

• Shortage Trends: While the number of counties with at least one primary care physician slightly increased, the overall number of primary care physicians per 100,000 population has continued to decline.

Acronym key:

Relative Value Scale Update Committee (RUC)

Relative Value Units (RVU)

Medicare Payment Advisory Commission (MedPAC)

Medicare Access and CHIP Reauthorization Act 2015 (MACRA)

Merit-Based Incentive Payment System (MIPS)

Medicare Economic Index (MEI)

William E. Fox, MD MACP is the Immediate Past Chair of the American College of Physicians, the country's largest medical specialty organization, representing internal medicine physicians, related subspecialists, and medical students.

Previously, Dr. Fox served as Chair of ACP’s Board of Governors and prior to that, he served as Governor of ACP’s Virginia Chapter. Dr. Fox has received numerous honors and recognitions including the American College of Physicians Virginia Young Internist of the Year award in 2010, the Paul Florentino Volunteerism Award in 2013 and the Richard Neubauer Advocate for Internal Medicine Award in 2014.

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW. 

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

Follow on social media:

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Join Dr. Libby Crockett as she talks with Joanna Murray and Cleo Zagurski from the Reproductive Health Collaborative, Nebraska to learn about Title X in the State of Nebraska and how HR1 affects the delivery of reproductive healthcare in our state.

Reproductive Health Collaborative Nebraska Advocacy Ask:

Contact your U.S. Senators and Representative and urge them to reach out to HHS and demand the immediate release of the Title X - Year 5 non-compete continuation application and guidance. Nebraska stands to lose over $2 million dollars for the coming year if Title X funding is not released, which will lead to possible clinic closures and Nebraskans not receiving life-saving preventative care.

Senator Fischer’s Office: 202-224-6551

Senator Ricketts' Office: 202-224-4224

Representative Flood’s Office: 202-225-4806

Representative Bacon’s Office: 402-938-0300

Representative Smith’s Office: 308-384-3900

Reproductive Health Collaborative Nebraska Links:

https://rhcnebraska.org/

https://incontrolnebraska.com/

Link to HR1 - One Big Beautiful Bill Act

https://www.congress.gov/bill/119th-congress/house-bill/1

If you have questions or answers, please email us at [email protected]

Please check out our website at: https://nebraskaallianceforphysicianadvocacy.org/

Nebraska Alliance for Physician Advocacy

Follow on social media:

@NEAllianceforPhysicianAdvocacy on Instagram

https://www.facebook.com/neallianceforphysicianadvocacy on Facebook

The views and opinions expressed on this podcast are solely those of the speakers and guests and do not necessarily reflect the official policy or position of their employers or any other organization or entity. This podcast is for informational and entertainment purposes only and does not constitute professional medical, legal, or financial advice. If you have a specific concern, please consult with a qualified professional.

Join Thanks to our guest today, Jed Hansen, PhD, APRN, FNP-C, who is the Nebraska Rural Health Association’s Executive Director. He and Libby Crockett, MD are discussing the Rural Health Transformation Fund which was established by HR1 (or the One Big Beautiful Bill Act) July 4, 2025.

He serves as the Nebraska Hospital Associations’s rural consultant. He is a native Nebraskan, growing up in the community of Minden. His academic background is focused on healthcare utilization facilitators and barriers in ambulatory care settings.

Dr. Hansen leads projects focused on the rural emergency hospital model, improving veteran access to care, and innovative community-level health economic models. He also works diligently to improve interoperability and data flow in rural health care settings and increase workforce pipelining.

Dr. Hansen is a fellow of the National Rural Health Association, the 2023 Rural Advocate of the Year and he recently published in JAMA on the impact of OBBA/HR1 on rural healthcare (read it here): https://pubmed.ncbi.nlm.nih.gov/40900579/

Additional Background on HR1 (OBBA)

Link to HR1 - One Big Beautiful Bill Act

NE DHHS text of Application- click here and scroll down to find text of application

https://www.cms.gov/priorities/rural-health-transformation-rht-program/overview

https://shvs.org/wp-content/uploads/2025/08/SHVS-Manatt-Rural-Health-Transformation-Fund-Discussion-8.28.25.pdf

https://shvs.org/tracking-state-preparation-for-the-rural-health-transformation-program/

Rural Health Association Links:

https://nebraskaruralhealth.org/

I Love Rural Health Program Link:

https://iloveruralhealth.com/

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW. 

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

Follow on social media:

@NEAllianceforPhysicianAdvocacy on Instagram

https://www.facebook.com/neallianceforphysicianadvocacy on Facebook

The views and opinions expressed on this podcast are solely those of the speakers and guests and do not necessarily reflect the official policy or position of their employers or any other organization or entity. This podcast is for informational and entertainment purposes only and does not constitute professional medical, legal, or financial advice. If you have a specific concern, please consult with a qualified professional.

*** Update: Due to end of the government shutdown full benefits are to be distributed for 150,000 Nebraskans on SNAP.

***Update since recording: On October 28, 2025 Nebraska DHHS officially announced that SNAP benefits in Nebraska are on hold for November. That means all 150,000 Nebraska SNAP participants won’t receive their benefits as scheduled on Nov. 1. Nonprofits like food banks and pantries will not be able to make up for the loss in  SNAP benefits, as SNAP provides 9 meals for every 1 served by a food bank. 

Link to: FRAC Email Portal to Federal Representatives on repealing cuts.

Link to: Appleseed blog on H.R.1 reconciliation impacts on SNAP and child nutrition programs

Link to: Appleseed blog on Oct 20th/Nov 1st DHHS implementation of H.R.1: 

Link to HR1 - One Big Beautiful Bill Act

Translated Flyer about Nebraska Food Banks

Guest: Eric Savaiano, is the Food and Nutrition Access program manager for Nebraska Appleseed’s Economic Justice Program.

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW. 

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

Follow on social media:

@NEAllianceforPhysicianAdvocacy on Instagram

https://www.facebook.com/neallianceforphysicianadvocacy on Facebook

The views and opinions expressed on this podcast are solely those of the speakers and guests and do not necessarily reflect the official policy or position of their employers or any other organization or entity. This podcast is for informational and entertainment purposes only and does not constitute professional medical, legal, or financial advice. If you have a specific concern, please consult with a qualified professional.

This episode edited by Rori Johnson.

Dr. Stephanie Hartman discusses changes to student loan policy changes within HR1 with Paula Kohles. Paula, is the current director of financial aid at the University of Nebraska Medical Center. She has over 30 years of experience in financial aid services within systems of higher education.  

Be sure to check out the show notes for any updates that may have occurred since the recording of the podcast on October 8, 2025. 

Link to HR1 - One Big Beautiful Bill Act

Link to outline of Student Aid changes from NASFAA. The National Association of Student Financial Aid Administrators (NASFAA) is a nonpartisan, nonprofit association that provides professional development and services for financial aid administrators, advocates for public policies that increase student success in postsecondary education, and conducts legislative and regulatory analysis related to federal student aid programs.

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW.  

If you have questions or answers, please email us at [email protected] 

Please check out our website at: Nebraska Alliance for Physician Advocacy 

Follow on social media: 

@NEAllianceforPhysicianAdvocacy on Instagram 

https://www.facebook.com/neallianceforphysicianadvocacy on Facebook 

The views and opinions expressed on this podcast are solely those of the speakers and guests and do not necessarily reflect the official policy or position of their employers or any other organization or entity. This podcast is for informational and entertainment purposes only and does not constitute professional medical, legal, or financial advice. If you have a specific concern, please consult with a qualified professional.

Join Stephanie and Matt as they discuss the intersection of writing, advocacy and physician wellbeing. 

Matt Mason served as the Nebraska State Poet from 2019-2024 and has run poetry workshops in Botswana, Romania, Nepal, and Belarus for the U.S. State Department. His poetry has appeared in The New York Times and Matt has received a Pushcart Prize as well as fellowships from the Academy of American Poets and the Nebraska Arts Council. His work can be found in Rattle, Poet Lore, Prairie Schooner, and in hundreds of other publications. Mason's 5th book, Rock Stars, was published by Button Poetry in 2023. 

Join NAPA and Matt Mason as we partner for an exercise in ode-writing to foster community around advocacy for our first in person event! Details on our social media for making a reservation for this June 28th event.

Find more at: https://matt.midverse.com/ and join his Patreon page for monthly releases: patreon.com/MattMason

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW. 

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

Follow on social media:

@NEAllianceforPhysicianAdvocacy on Instagram

https://www.facebook.com/neallianceforphysicianadvocacy on Facebook

https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=59590

Introduced by Senator Jacobsen, January 22nd

Banking, Commerce and Insurance Committee

Apr 03, 2025, Passed on Final Reading with Emergency Clause 47-0-2, Excused, not voting are the only “2” votes

Approved by Governor on April 7, 2025

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW.

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

LB 676 was advanced by the Health and Human Services Committee to General File as a combination of three separate pieces of legislation proposed: 

LB 701, LB 374 and LB 676.

We will discuss the changes in this podcast as well as two amendments proposed after advancing to General File. Amendment 914 would remove the licensure for certified professional midwives from the bill if passed.

Link to the committee report: https://nebraskalegislature.gov/FloorDocs/109/PDF/CS/LB676.pdf 

Link to the bill page for LB676:

https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=59164&docnum=LB676&leg=109

Link to AM914 from Senator Fredrickson: 

https://nebraskalegislature.gov/FloorDocs/109/PDF/AM/AM914.pdf

Chart comparing education requirements among the groups outlined:

https://nebmed.org/wp-content/uploads/2025/04/Provider-Education-Comparison_PDF-1.pdf

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW. 

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

Follow on social media:

@NEAllianceforPhysicianAdvocacy on Instagram

https://www.facebook.com/neallianceforphysicianadvocacy on Facebook

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to ⁠⁠DONATE NOW.⁠⁠ 

In this episode, Rachel and Libby review what is happening at this mid-point in the 2025 legislative session.

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The Speaker’s announcements on intended schedule and procedure for the session: speaker

Nebraska budget process: https://nebraskalegislature.gov/about/budget_process.php

Open Sky’s Overview of Nebraska’s Budget and Tax Policy (deeper dive - may make more sense to hold until budget episode): https://www.openskypolicy.org/wp-content/uploads/2024/12/2023_OpenSky_BudgetPrimer.pdf

Open Sky’s Demystifying State Budget recording: https://www.youtube.com/watch?v=10TWNRYY-Qg&t=1s

Governor Pillen’s budget proposal: https://das.nebraska.gov/budget/publications/docs/2025-2027/2025/ExecutiveBudgetinBrief2025-2027Biennium.pdf

Appropriations initial budget proposal: https://nebraskalegislature.gov/pdf/reports/fiscal/2025prelim.pdf

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

Follow on social media:

@NEAllianceforPhysicianAdvocacy on Instagram

⁠https://www.facebook.com/neallianceforphysicianadvocacy⁠ On Facebook

And check out our blog on Substack:

Nebraska Alliance for Physician Advocacy on Substack

Dr. Stephanie Hartman is joined by Eric Saviano with Nebraska Appleseed to discuss food security in Nebraska and several legislative bills in this area.

Eric is the Food and Nutrition Access program manager for Nebraska Appleseed’s Economic Justice Program. In this role he focuses on strengthening policies and programs that help people get the food and nutrition they need.

Nebraska Food Access Bill Overview 2025

Bills discussed today:

LB192, Eliminate a sunset date under the Supplemental Nutrition Assistance Program, introduced by Senator Dan Quick

LB319, Change eligibility requirements for the Supplemental Nutrition Assistance Program, introduced by Senator Victor Rountree

LB46, Establish a Restaurant Meals Program under the Supplemental Nutrition Assistance Program, introduced by Senator Terrell McKinney

LB656, Change work requirements under the Supplemental Nutrition Assistance Program, introduced by Senator Bob Andersen

LB14, Hunger-Free Schools Act, introduced by Senator Machaela Cavanaugh

We rely on your donations to keep producing this podcast content and to support physician advocacy in Nebraska. If you would like to support Nebraska Alliance for Physician Advocacy, a 501(c)(3) organization in Nebraska please click to DONATE NOW. 

If you have questions or answers, please email us at [email protected]

Please check out our website at: Nebraska Alliance for Physician Advocacy

Follow on social media:

@NEAllianceforPhysicianAdvocacy on Instagram

⁠https://www.facebook.com/neallianceforphysicianadvocacy⁠ On Facebook