Inside the American Medical Association’s sudden strategy shift in Washington

STAT News – Wednesday, August 13, 2025
By Theresa Gaffney

At the annual meeting of the American Medical Association’s House of Delegates in June, the mood was tense. Hundreds of physicians had congregated in Chicago to vote on the organizations’ key policies. The AMA is the largest professional association for physicians, as well as a political lobbying group with a strong, if waning, presence on Capitol Hill.

As the Trump administration had begun embracing policies that diverged from medical consensus and conflicted with AMA policies, the group had employed a behind-the-scenes battle strategy, honing in on closed-door discussions with lawmakers as the place to push for sound science, evidence-based medicine, physician autonomy, and higher payments. But AMA members were now worried that this strategy, sometimes referred to as “quiet advocacy,” was not working.

Within days of his inauguration, President Trump had signed executive orders targeting diversity initiatives, the fundamental science of sex, and gender-affirming care for youth. Robert F. Kennedy Jr., a long-time vaccine critic, had been confirmed as the country’s health secretary with the key vote of Sen. Bill Cassidy (R-La.), a physician. And major cuts to Medicaid funding were on the table in the budget reconciliation process.

Publicly, the AMA said nothing — even as members “begged” leadership at the organization to act more forcefully, according to Laurie Lapp, an OB/GYN resident who served on an AMA council that reviews and makes recommendations on proposed federal legislation.

But in recent weeks there’s been a change in tone, with the AMA issuing a slew of public statements critical of decisions made by the administration. STAT interviews with half a dozen members of the organization as well as its leadership shed light on what led the organization to bring its advocacy work out of the shadows.

A crucial turning point came on the fourth day of the House of Delegates meeting, when news broke that Kennedy had disbanded the Advisory Committee on Immunization Practices and intended to replace them with hand-picked vaccine skeptics.

The AMA leadership reflexively issued a statement that many delegates saw as weak. “We all wanted to see action,” one attendee told STAT.

The Trump administration’s quick success in passing the tax bill last month, despite vigorous lobbying against its sweeping Medicaid and other health care spending reductions, indicates to some experts that the health industry’s influence in Washington has waned, leaving groups like the AMA with little to no ability to push for change. At the same time, the AMA boasts its highest membership numbers since the 1940s. Physicians are increasingly looking to the organization for leadership. Many — particularly those who are younger and working within primary care specialties — want to see more public statements and bolder action from the organization on issues like the overhaul at federal health agencies, research funding cuts, Medicaid, vaccines, drug pricing, gender-affirming care, and more.

In early June, as they gathered in person with leadership new and old, their protests finally were heard.

“We have to be the voice of medicine,” John Whyte, who took over as CEO of the organization on July 1, said in an interview with STAT. An internist and former chief medical officer at WebMD, Whyte attended the meeting and heard the pleas from colleagues angry that the organization wasn’t doing more to push back against what was happening in Washington.

“We have to stand up for science,” he said. “People look to the AMA to do that. And I’m not sure I always realized that to the degree that I recognize it now.”

Keeping a target off its back

The AMA has, in recent years, been caught in the middle. While physician payment reform and thwarting Medicare payment cuts have long been the main focus of the AMA’s advocacy, its newer members pushed to broaden the policy agenda to include health issues like abortion and gender-affirming care. “The perception of the House — whether or not this was the case — was that the AMA was sort of shirking its responsibility on a lot of other issues,” said Rohan Khazanchi, a medicine-pediatrics resident and member of the House of Delegates. At the same time, Republicans accused the organization of “wokeism.”

At a meeting in November, some physicians in the House of Delegates called into question a potential policy supporting the subsidization of insurance coverage for people without legal status through the Affordable Care Act exchanges. One physician argued that supporting the idea would “put a target” on the organization’s back, but the comment, one delegate told STAT, was rebutted by another who said — to applause — that the organization should have a target on its back.

The policy passed. But that doesn’t always translate to public advocacy.

The AMA has a policy specifically supporting gender-affirming care and opposing restrictive or punitive legislation. Yet the group made no statements as Trump signed an executive order attempting to restrict the care, nor when HHS released a major report contradicting the AMA’s medical guidance. (The AMA did release a statement opposing the Supreme Court’s decision this year regarding Tennessee’s ban on gender-affirming care for youth. Last year, the group submitted an amicus brief in the case supporting trans youth.)

In late February, every state medical professional organization joined together to send a letter urging Congress to protect Medicaid from spending cuts. The AMA, which has numerous policies supporting robust Medicaid funding and expansion, did not sign on or send its own letter. In March, AMA delegates from pediatrics, OB/GYN, and internal medicine groups wrote to Michael Suk, then chair of the organization’s board, asking trustees to publicly oppose cuts, mobilize the advocacy team, and collaborate with state and speciality societies to oppose the cuts.

“Silence is not inaction,” Suk, who finished his one-year term as chair in June, responded. “Reactive activism can be risky — it can divert attention from larger, long-term goals. … We are actively engaging with the administration, lawmakers, and key stakeholders across medicine.” (Two months later, AMA leadership did write letters to the House Energy and Commerce Committee and to House leadership outlining concerns about Medicare and Medicaid, among other issues, in a budget reconciliation bill.)

Physicians who spoke to STAT expressed appreciation for the importance of behind-the-scenes advocacy, but felt the current moment called for a radically different approach. “The advocacy strategy of closed-door [meetings] is okay in many situations, but when it’s something that is an existential threat to the profession, we need to see the physician standing up loudly and clearly and with a unified message,” Khazanchi said.

At a meeting of the AMA’s Council on Legislation in February, Lapp said, “it was me and a few other council members just begging advocacy staff to communicate with AMA members about what their strategy was.” Other organizations were publishing health data removed from federal government websites on their own sites — Lapp asked if the organization could do that. “They would say, ‘okay, we’ll consider it.’ And then nothing ever became of it,” she recalled.

Not everyone disagreed with the speak-softly approach, Suk said in comments shared over email with STAT. “We also heard strong support for our strategy — particularly from those who recognized the cycle of challenge that seemed to characterize the whirlwind of changes being proposed daily, often in unprecedented fashion,” he wrote, noting that the political environment required an approach that “avoided unnecessary escalation.”

One House of Delegates member, who requested anonymity due to fear of retaliation, observed that the strategy was consistent with the practices of an organization this old, large, and “this keen to maintain proximity to power and authority.”

It’s unclear how close the AMA is to the country’s top health authorities. Organization leadership and advocacy staff have not met directly with Kennedy or Mehmet Oz, who leads the Centers for Medicare and Medicaid Services, according to Whyte.

For Lapp, Kennedy’s nomination to lead HHS was “the moment where the AMA’s voice would have made the most difference.” At his confirmation hearing in March, Kennedy not only voiced doubts about vaccines but stood by previous comments that common antidepressants could be responsible for school shootings, and made incorrect claims about the warning label on these SSRI drugs. The AMA made no statement on the nomination — among major groups representing health professionals, only the American Public Health Association officially opposed it — which some believed was because it didn’t seem possible to stop it.

AMA delegates call for ‘actual action’

Physicians’ frustration with their leadership bubbled up at the AMA’s annual meeting, where House of Delegate members representing a wide array of specialties, regions, and interests meet to debate and vote on proposed resolutions that guide the organization’s advocacy priorities. On the fourth day of the meeting, Kennedy abruptly fired all 17 members of the Advisory Committee on Immunization Practices, a panel of experts that issues recommendations on the use of vaccines.

The AMA quickly released a statement from then-president Bruce A. Scott condemning the move, saying it “upends a transparent process that has saved countless lives.” But physicians at the meeting weren’t satisfied. “‘Okay’ is the best way I would describe it,” M.D.-Ph.D. candidate and delegate Ryan Englander said about the statement, while acknowledging that it’s difficult to quickly pull together a thorough rebuttal.

The delegates voted to consider an emergency resolution on the firings, a rare occurrence. The resolution proposed that the AMA advocate publicly to support the current ACIP structure, including sending a letter to Kennedy calling for him to reverse the decision, and another to the Senate health committee requesting an investigation into the firings. And if necessary, the resolution called for the AMA to “identify and evaluate alternative evidence-based vaccine advisory structures and invest resources in such initiatives.”

Two members requested that the call for an investigation be eliminated or referred to the Board of Trustees for review. Ohio physician John Corker said the call would be a “poison pill” for the rest of the AMA’s legislative agenda, as MedPage Today reported at the time. But the resolution had widespread support and was approved without such amendments.

“That entire story speaks to the mood of the house,” Englander said. “We wanted it to be actual action and not just putting out a press statement.”

That defiant mood extended to discussions about other resolutions, especially ones concerning the administration’s sweeping cuts to Medicaid and other health programs, which the Congressional Budget Office recently estimated would cause 10 million Americans to lose health insurance.

At one committee meeting, delegates were instructed to line up behind one of two microphones — one for “pro” arguments on a resolution, and one for the “con” side — to offer their views on several resolutions that proposed the AMA make the preservation of Medicaid funding an urgent legislative advocacy priority. The line at the “pro” microphone curled around the back of the room. Nobody spoke from the “con” mic.

While the AMA has long prioritized lobbying for increased physician payments from government programs, people who were there told STAT that nobody testified about payment.

Instead, physicians talked about their patients who could have died if they hadn’t been able to access care with Medicaid coverage, or who would have been buried in debt to pay for that care. The resolutions were combined and adopted.

“There was absolutely no pushback,” said Lapp, who helped to author one of the resolutions.

What’s next: You’ll hear more from the AMA

Less than a month before he took on the CEO role, Whyte attended the annual meeting, and spent hours listening in to the committee meeting that considered the Medicaid resolutions. Rather than feel defensive as the incoming top executive, the outpouring from physicians left him “inspired,” he said.

“It wasn’t the typical meeting,” Whyte said. “They feel passionately about it … and want to create change, and are using the AMA because they realize the value of the AMA.”

Whyte and other representatives of the AMA emphasized that the membership is at a modern high, with just over 300,000 physicians. And as membership has grown, its political affiliations may also be shifting. In the ’90s and early aughts, the AMA typically donated much more money to Republican candidates than to Democrats. But since 2020, that seems to have flipped, with more money going blue. In a 2021 speech, then-CEO James Madara emphasized that advocacy, a focus on equity, and combatting misinformation during the pandemic were keys to attracting and maintaining membership.

“People are interested in what the AMA has to say,” Whyte said. “People want us to be that voice and advocate.”

When asked about how the AMA’s strategy of communicating with both its members and the public may need to change, Whyte contended that it already had. “Have you heard more from the AMA in the past month?” For anyone following the organization, the answer is likely yes. In the weeks after the annual meeting, the group posted more on social media platforms about the looming Medicaid cuts than earlier in the year.

When the legislation passed, new AMA President Bobby Mukkamala said in a statement that “this bill moves us in the wrong direction.” And when the news broke that Kennedy was preparing to fire all members of the U.S. Preventive Services Task Force, the organization posted online that it was “deeply concerned” about the reports, and immediately sent a letter to Kennedy urging him not to do it.

The change is both a reaction to the noise that physicians made at the annual meeting and something that was long in process, Whyte said. Mukkamala, who has been recording videos about the AMA’s concerns about administration policies, was elected by the House at last year’s meeting. Many delegates are hopeful that newly elected board members will also push for more public advocacy.

In a speech before the House of Delegates in June, Suk, the board chair, acknowledged that “there have been times when we could have spoken louder, earlier, and more forcefully in defense of science, the patient‑physician relationship, and the integrity of our profession.”

But while Trump’s tax bill will trim health care spending by more than $1 trillion over the next decade, Suk pointed out that, had the AMA done nothing, even steeper cuts, more reduced eligibility, or limited benefits could have been imposed. “Our strategy has never been to declare victory or defeat based solely on the wholesale adoption or failure of a legislative vehicle,” he wrote in an email.

Whyte says the AMA hasn’t given up on Medicaid.

“You live to fight another day, right?” he said. “It’s not like, okay, we didn’t win on that so we’re done.” They weren’t able to stop the passage of the bill, but they plan to be there fighting as it’s implemented. Doctors will be watching.

Access this article at its original source.