Why It Matters

The Federation of American Hospitals is fighting to prevent a financial crisis for its 1,000-plus member hospitals. Rural facilities face closure without Medicaid relief, while Medicare Advantage payment delays and site-neutral payment policies threaten operations nationwide.

The FAH deploys five in-house lobbyists with deep Medicare expertise and Republican Capitol Hill connections to influence active congressional debates. They’re pushing the Healthcare Workforce Resilience Act to address staffing shortages, backing the Medicare Advantage Prompt Pay Act to stop payment delays, and fighting site-neutral payment expansions. They’re also seeking extension of Enhanced Premium Tax Credits—expiring at year’s end—to prevent uninsured surges that increase hospitals’ uncompensated care costs.

By the Numbers

The Federation of American Hospitals spent $725,000 on in-house lobbying during Q3 2025. Charles N. Kahn III and Steve Speil have represented FAH since 2003, accumulating over $56 million and $53.8 million in reported expenditures respectively.

The current team adds fresh Capitol Hill expertise. Charlene K. MacDonald previously served as Senior Policy Adviser for Medicare on the Senate Budget Committee. Rebecca Heilig Lira worked in Rep. Steve Scalise’s office before joining FAH in 2021.

FAH has maintained continuous lobbying presence since 2003, filing 483 total disclosures and spending nearly $71 million on healthcare policy advocacy.

The Agenda

The Federation of American Hospitals is targeting four major healthcare policy areas.

The organization is pushing the Healthcare Workforce Resilience Act to address severe physician and nurse shortages and seeking Medicare Advantage reforms, particularly addressing prior authorization delays and payment denials. The FAH is fighting proposed site-neutral payment expansions that would reduce reimbursement rates and lobbying to prevent Medicaid Disproportionate Share Hospital funding cuts while extending Enhanced Premium Tax Credits.

These align with urgent congressional debates. Lawmakers are considering the Medicare Advantage Prompt Pay Act following hearings documenting excessive payment delays. Senator John Kennedy’s Same Care, Lower Cost Act proposes site-neutral payments that hospitals oppose.

Broader Context

Congress is grappling with multiple healthcare crises motivating FAH’s agenda. Rural hospital closures have accelerated, with nearly 100 shuttered in the last decade. While Congress authorized a $50 billion Rural Health Transformation Fund, the Trump administration capped direct hospital payments at just 15%.

Enhanced Premium Tax Credits expire at year’s end, potentially doubling average ACA premiums. Medicare Advantage prior authorization delays have drawn House scrutiny, with estimates of $84 billion annual taxpayer overspend.

On workforce, over 77 million Americans live in primary care shortage areas, but a recent executive order increased H-1B visa fees from $3,500 to $100,000, complicating hospital recruitment.

Between The Lines

A House Ways and Means Committee hearing documented widespread Medicare Advantage delays, with taxpayers overspending an estimated $84 billion annually versus traditional Medicare. The bipartisan Medicare Advantage Prompt Pay Act addresses these issues.

Senator John Kennedy introduced the Same Care, Lower Cost Act to expand site-neutral payments, which proponents argue could save Medicare $157 billion over a decade—directly threatening hospital revenue.

On rural hospitals, Senator Jon Ossoff has warned of closures, while the Save America’s Rural Hospitals Act has been introduced for financial relief.

Competitive Landscape

The Federation of American Hospitals faces competition from other hospital groups. The Tennessee Hospital Association and UPMC are also fighting site-neutral payment expansions.

FAH shares priorities with major healthcare organizations. HCA Inc. similarly lobbied on Enhanced Premium Tax Credits extension. The American Hospital Association supports the Healthcare Workforce Resilience Act that FAH champions.

The Bottom Line

The FAH’s agenda directly addresses major policy debates consuming Congress, from Medicare Advantage reform to rural hospital funding and workforce visas. The organization’s priorities align with urgent congressional concerns affecting millions of Americans.