A new fight over the cost of having children is the latest front in a broader Republican campaign against the American Medical Association (AMA), with lawmakers accusing the nation’s largest physician group of leveraging its monopoly over medical billing codes in ways that could increase healthcare costs for families at a time when President Donald Trump and Republicans are honing in on affordability and cost of living issues.
The controversy erupted after CBS News reported that a major overhaul of maternity billing codes scheduled to take effect next year could result in more itemized charges for pregnancy, childbirth and postpartum care. Under the new framework, physicians would move away from a long-standing bundled payment model and instead bill separately for many maternity services.
Rep. Diana Harshbarger (R., Tenn.) accused the AMA of making childbirth more expensive and renewing conservative calls for Congress to challenge the organization’s control over the nation’s medical billing infrastructure.
“The AMA now wants to make having a baby MORE expensive,” Harshbarger noted. Harshbarger, a longtime pharmacist, also argued that the AMA’s role in developing Current Procedural Terminology (CPT) codes amounts to a government-backed monopoly that ultimately drives up healthcare costs.
The comments reflect a growing view among congressional Republicans that the maternity code overhaul is not an isolated policy change but part of a larger debate about the AMA’s influence over how American healthcare is billed and paid for.
At the center of the dispute are new maternity care codes approved by the AMA that will take effect in January. Critics warn that shifting from a bundled payment structure to a more a la carte system could increase the number of billable services associated with pregnancy and make it harder for families to predict what childbirth will ultimately cost. The CBS News report noted that patient advocates have questioned whether the changes will improve outcomes or simply lead to higher bills.
For years, policymakers have tried to move healthcare away from a system that pays doctors more simply for doing more services. Instead, they have encouraged payment models that reward providers for coordinating care and achieving good outcomes. Pregnancy has traditionally been treated as one continuous episode of care, with prenatal visits, delivery, and postpartum care bundled together. The new maternity codes move away from that approach by allowing different parts of pregnancy care to be billed separately, which could in turn lead to higher costs.
The AMA and the American College of Obstetricians and Gynecologists, however, dispute that characterization. In materials distributed to congressional offices, the organizations argue that maternity care has changed dramatically since the current coding framework was established. They also argue that the changes are expected to be budget neutral and will not increase patient cost-sharing.
Patient advocates, however, are raising concerns about how the changes could affect pregnant women. Caitlin Donovan, a senior director at the Patient Advocate Foundation, has described weekly ultrasounds recommended during one of her pregnancies as a “money grab.”
Federal officials spent years trying to prevent healthcare providers from breaking a single service into multiple charges because doing so can lead to higher costs and improper payments. Critics say the new maternity billing system moves in the opposite direction by splitting pregnancy care into more separate billable pieces instead of encouraging coordinated care.
Questions about waste, fraud and abuse have also become part of the discussion. The Department of Health and Human Services (HHS) Office of Inspector General routinely identifies coding and billing problems that lead to improper payments across federal healthcare programs. In one audit, investigators found Medicare made up to $17.8 million in potentially improper payments tied to coding and billing issues involving separately reported services.
The dispute comes as the cost of raising children has become a central concern among conservatives who have increasingly embraced pro-family policies aimed at reversing declining birth rates. The U.S. recorded its lowest fertility rate on record in 2024 and surveys consistently find that concerns about housing costs, childcare expenses, healthcare bills and overall affordability are among the leading reasons young Americans delay marriage or postpone having children.
The maternity coding controversy also lands amid a year-long escalation between congressional Republicans and the AMA over issues far beyond obstetrics.
Last year, the Washington Reporter was first to report on how the windfall from the AMA’s CPT coding system monopoly, which amounts to hundreds of millions of dollars annually, could be used to fund partisan lawfare against President Trump and his priorities.
Last fall, Senate Health, Education, Labor and Pensions Committee Chairman Bill Cassidy (R., La.) launched a formal inquiry into the AMA’s management of the CPT coding system, accusing the organization of abusing what he called its “government-endorsed CPT monopoly.” Cassidy questioned the AMA’s licensing practices, the revenue generated by CPT codes and whether those revenues were being used to support activities unrelated to patient care.
“I am particularly offended by the AMA abusing its government-endorsed CPT monopoly to charge every stakeholder in the health care system significant amounts of money while advancing an anti-patient agenda,” Cassidy said at the time.
More recently, House Oversight Committee Chairman James Comer (R., Ky.) opened a separate inquiry into the CPT system, requesting information from the Centers for Medicare and Medicaid Services about the federal government’s reliance on AMA-owned billing codes. Comer questioned whether the complexity of the coding system contributes to improper payments, administrative waste and higher healthcare costs.
Taken together, the Cassidy and Comer investigations have elevated what was once an obscure debate about medical billing into a broader political fight over transparency, healthcare costs and the AMA’s role in shaping reimbursement across the healthcare system.
The scrutiny is unfolding as relations between the AMA and Republicans continue to deteriorate.
At the AMA’s annual meeting this month, physician delegates elected Atlanta internist Dr. Sandra Fryhofer as president-elect after she argued the organization had been “too silent and too timid” in confronting the Trump administration and HHS Secretary Robert F. Kennedy Jr. According to Politico, many physicians within the organization are pushing AMA leadership to take a more aggressive posture toward Kennedy and his health agenda, even if doing so comes at a political cost.
As the Trump administration and Congressional Republicans increasingly frame healthcare affordability as a family issue rather than simply a healthcare issue, the fight over maternity billing codes may prove to be the most politically potent test yet of the AMA’s standing in Washington.
