I remember visiting Capitol Hill as a 7-year-old girl as a part of a tour in Washington, DC. I never imagined I would return to the same marble steps, this time as a voice for my patients and the health care community, by participating in the Legislative Conference.

During this year's conference we visited the Hill during a government shutdown, but that did not deter us from achieving our goals. The symbolism was striking – even when systems stall, the call to serve and speak up for our community waits for no one.

As a fellow in cardiovascular medicine, I want to go above and beyond for my patients, but sometimes system-based hurdles block my path. Initially, I was frustrated, voicing concerns without a clear resolution. Although I had heard about ACC's Legislative Conference in years past, I had never before considered being a voice for change. This year, I realized the only way forward is to advocate for policy changes at the federal level.

My first step beyond the hospital walls and into the legislative arena started by connecting with our Legislative Conference advisors. These veteran attendees walked us first-timers through the process on Sunday evening. The next day featured several structured sessions discussing issues such as physician burnout, prior authorization reform and the importance of telehealth for our patients.

A highlight of the program was a live REMARKable conversation led by ACC President Christopher M. Kramer, MD, FACC, providing an overview of the changes and impact of the 2026 Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System proposed rules to cardiovascular clinicians. Shielded by the rose-colored lens of my training environment, I was stunned to learn that Medicare physician payment cuts have led to over $700 million in losses to cardiology services nationwide in just a few short years. Reforms like adding an annual payment adjustment based on the Medicare Economic Index and increasing the budget neutrality threshold felt increasingly needed and urgent. These insights sparked a deeper interest in health policy and its far-reaching impact on patient care.

We then learned about the conference's talking points, with panel discussions led by ACC's Congressional Affairs team. Key asks included:

• Establishing sustainable Medicare payment practices by enacting long-term reform of the Medicare payment system.
• Streamlining prior authorization practices by advancing the Improving Seniors' Timely Access to Care Act (H.R. 3514/S. 1816).
• Advocating for the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act (H.R. 4206/S. 1261), aimed at expanding coverage of telehealth services through Medicare and making COVID-19 telehealth flexibilities permanent.
• Championing the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act (H.R. 783/S. 248), allowing patients to receive in-home cardiac and pulmonary rehabilitation services, including telehealth services, under Medicare.
• Seeking congressional support for the Connected Maternal Online Monitoring Act (H.R. 4977/S. 141), to provide coverage recommendations for remote monitoring devices for pregnant women to ultimately improve health outcomes for pregnant and postpartum women.
• Advocating for my peers and future cardiologists by increasing cosponsors for the Resident Education Deferred Interest Act (H.R. 2028/S. 942), which would prevent interest accumulation on student loans during medical internships and residencies.

Armed with all the information needed for successful Hill meetings, each state chapter divided their talking points among residents, fellows, cardiologists, cardiovascular team members and administrators, showcasing the collective strength of the cardiovascular care team.

Rays of sunshine greeted us on Hill Day, adding warmth and zeal as we headed to our scheduled meetings. Walking through the halls of the congressional office buildings was surreal, and I was determined to do my bit as part of ACC's Nebraska Chapter.

Each meeting was encouraging as we explained our requests and provided insight into the reality of modern cardiovascular care delivery. There was a mutual appreciation for the work we do for our citizens and patients, fostering a sense of unity and accomplishment.

By the end of the day, there was a sense of fulfillment in me. We were more than 400 voices stepping outside our clinical routine to help shape the systems that govern cardiovascular care. Irrespective of one's role in the health care team, advocacy is a shared responsibility. Progress in cardiovascular health can only occur with a unified front, where every member of the care team contributes to the conversation that drives change.

This article was authored by Amrin Kharawala, MD, a cardiovascular medicine fellow at the University of Nebraska Medical Center in Omaha.

Keywords: Cardiology Magazine, ACC Publications, Legislative Conference, ACC Advocacy, Washington