Healthcare, Therapy, and the Senate

Fixing healthcare is simple: More people need preventative, conservative care earlier.

But getting to this fix is a massively complex web of structural policy choices. The reality is that our modern healthcare system often misaligns incentives, rewarding the management of chronic sickness over the investment in wellness. We’ve seen a shift toward market consolidation, where vertically integrated monopolies—both in insurance and hospital systems—drive up prices while limiting choice.

It’s this playbook—which includes a lack of site-neutrality, high specialist payments, and insufficient transparency—that has allowed consolidated systems to post record revenues, even as:

• Medicaid is cut

• Insurance premiums are up

• Rural hospitals close

• Frontline workers experience burnout and higher suicide rates.

• The US pays the most in the world for healthcare, without the leading outcomes to show for it.

As therapy providers, we have watched as our common-sense bills collect dust. Our care is denied, our expenses are skyrocketing, and our reimbursement is stagnant because Medicare budgets are squeezed and commercial rates are failing to close the gap. We’re fighting red tape to provide simple telehealth, while “AI Therapist” expands with a fraction of our professional oversight.

That’s why I wanted to have U.S. Senate Candidate Dan Osborn on the podcast. I wanted to talk about therapy in the Senate. Why aren’t we making true progress? How do we move our bills forward? And what does it take to tackle these structural failures?

1. You will be able to identify current federal legislative bills that aim to improve therapy reimbursement and practitioner status.

2. You will be able to recognize how structural market shifts, such as vertical integration and site-neutral payment reform, impact the therapy profession.

• Intro

• Discussion

  • What motivates you to take on a candidate whose family is about 82,000x wealthier than you?

  • It feels like everywhere the money of the few is winning over the common good. Why does it feel like progress isn’t being made on kitchen table issues (like healthcare.)

  • Living in a farming community, I see first hand how large corporations are taking more and more of the farming pie, while the farmers doing the work get less and less. Now I see that happening in healthcare, what can be done to protect the people (farmers, therapists, & other frontline workers) who are doing essential work?

  • When I heard you speak, I really resonated with what you had to say about the VA. To me the VA is the place, where OTs get to practice at the top of our license and really provide holistic care. And, most importantly the VA historically has had really good health outcomes. Can you explain the move towards privatization and if that is the best move in your opinion?

  • As therapists, we’ve been very concerned about the federal cuts to Medicaid—these are the patients on our caseloads, and we know how critical this funding is for their care. (Especially considering that nearly half of all Nebraskans on Medicaid are children, and it’s the primary source of healthcare for 1 in 3 kids in our state.)
    In Nebraska, we’ve already seen 1 hospital close (in Curtis), and 44% of rural hospitals are already operating at a loss. From your perspective, why is our safety net for rural communities and CHILDREN feel like is failing while the ‘middlemen’ are seeing record profits? And what can be done about this?

  • In therapy we have multiple common-sense bills that are collecting dust. What is your advice for how we make progress on these bills?

    1. Telehealth provisions (S.3834 – Expanded Telehealth Access Act)

    2. OTs as mental health providers (H.R.4037 – Occupational Therapy Mental Health Parity Act.)

       • This would require Medicare to clarify and ensure OTs to bill for OT services to patients with a mental health diagnosis

    3. Repealing MPPR for therapy H.R.8386 – RECOVER Act of 2026

       • This is asking for a strange rule that slashes our reimbursement if we bill more than one unit or service on the same day.

    4. Getting rid of our loan cap S.4039 – Professional Degree Access Restoration Act

       • For some reason in the middle of a workforce shortage, the federal government capped the amount of federal loans therapy professionals qualify for- making therapy school inaccessible for many.

    5. Getting PT/OT added to FQHCs H.R.5621 – Physical Therapist Workforce and Patient Access Act of 2025

       • For some reason, Federally Qualified Health Centers cannot bill for OT/PT as a standalone service currently.

    6. Allowing for Private Pay Medicare Patient Choice Act (H.R. 4204)

       • This would finally let OTs and PTs ‘opt out’ of Medicare if they want to, allowing us to work directly with patients via private pay—just like doctors and nurses have been allowed to do for decades.

    7. Additional issues:

       • OTs and PTs are codified in statute as suppliers instead of practitioners- that needs to change.

       • Site neutral payment reform – why are we paying so much more to hospital systems versus small outpatient clinics for the same services

  • As health professionals – we spend SO MUCH energy fighting red tape and healthcare giants on behalf of our patients. And, now we have a new competitor “AI therapists”- who it feels like benefits from a medical title but is free from the burdens of medical license. What is your take on how we harness AI versus giving it free range?

  • As therapists, we see first hand everyday how our systems are failing our patients. Because of this, I know multiple therapists who are interested in running for public office. What advice do you have for them?

  • I have a pretty simple vision for the future of healthcare, where more people need preventative, conservative care earlier, through more team-based primary care (and our payment models and technology support this effort.) What’s your vision for the future of healthcare in this country?

• Live Q&A

• Closing

• Medicare Site-Neutral Payment Policies: Effects Of Proposals On Hospitals And Beneficiary Groups

• Cost, Quality, and Utilization After Hospital-Physician and Hospital-Post Acute Care Vertical Integration: A Systematic Review

• All-Cause Mortality Following Veterans Affairs and Community Mental Health Residential Treatment

• Exploring Reimbursement Pathways for Lifestyle Medicine and Health Promotion Services in Occupational Therapy

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

OT Potential typically pays guest speakers an honorarium for their participation, either directly or to an institution of the speaker's choosing at their request. No honorarium or other payment was made in connection with this course. We invite guests whose expertise often comes from practices, programs, or building products in their field. Where a speaker has a financial interest in the subject of a course, we disclose it below so you can weigh it for yourself.

OT Potential's interest in this topic: We have no financial stake in this topic. OT Potential has made no contribution to and receives no compensation from any political campaign.

Speaker interests: Dan Osborn is a candidate for U.S. Senate in Nebraska. No honorarium was paid for his participation. This interview is presented for educational purposes only and does not constitute an endorsement by OT Potential.