Four days in May

Four days in May 2017 were a perfect illustration of how the American College of Physicians develops and influences public policy for the benefit of internists and patients.

The four days overlapped with ACP's annual Leadership Day on Capitol Hill, when over 400 ACP members from 47 states, D.C., and the Virgin Islands met with their senators and representatives to advocate for College priorities. But Leadership Day was bookmarked by other events that promised to have a huge impact on health care. Here's a rundown.

Monday, May 22

ACP's Health and Public Policy Committee met to develop policy recommendations to the College's Board of Regents on social determinants of health, barriers to women's health, the gender pay gap affecting female physicians, hate crimes as a public health issue, patient safety in the office-based ambulatory setting, reinvention of performance measures to make them more relevant and less burdensome, and more.

The same day, President Trump's administration asked a federal court to give it another 90 days to determine if it would continue to defend against a lawsuit that had been brought by the House of Representatives against the prior Obama administration and that carried over to the new one. If successful, the suit would destabilize insurance markets nationwide.

Under the Affordable Care Act (ACA), health plans sold through individual insurance marketplaces get federal subsidies, called cost-sharing reduction (CSR) payments, so that they can offer lower deductibles to low-income people as the ACA requires them to do. While the legal issues are arcane, a ruling by the court, or a decision by the administration to drop its defense against the lawsuit or to discontinue the CSR payments on its own, would result in premium increases next year of 20% or more and far fewer insurers selling coverage, according to independent analysts. ACP strongly supports continuation of the CSR payments.

Tuesday, May 23

Early in the morning, ACP released a new policy statement, called “A Prescription for a Forward-Looking Agenda to Improve American Health Care,” which argued that “The continued polarization and partisanship over the future of the Affordable Care Act (ACA) is standing in the way of making progress on a range of issues that are essential to improving our health care system.”

Instead of re-litigating the ACA, ACP urged Congress and the administration “to join with ACP and other clinician and patient advocacy groups to create and implement a forward-looking agenda to improve American health care” that would:

• expand access and coverage,
• bring greater value for the dollars spent,
• reduce the crushing administrative burden on physicians and patients,
• leverage technology to improve patient care,
• support a well-trained physician workforce,
• reduce barriers to care of patients with chronic diseases, and
• support scientific research and policies to improve public health.

Leadership Day attendees were then briefed on ACP's agenda and how they could advance it in their Hill visits the following day. They also heard from administration and congressional staff on their priorities and the political realities they would confront.

The same day, President Trump released his budget proposals for the federal fiscal year, which starts on Oct. 1. If accepted by Congress, the budget would result in sweeping reductions in funding for medical and health services research, primary care training, disease prevention and control, substance use treatment, and Medicaid.

Wednesday, May 24

The day started with Leadership Day attendees hearing remarks from Representatives Ami Bera, MD, FACP (D-CA), and Kathy Castor (D-FL) and from Karen DeSalvo, MD, MPH, MSc, FACP, former assistant secretary for health and national coordinator for health information technology. Dr. DeSalvo was on hand to receive ACP's prestigious Joseph F. Boyle Award for Distinguished Public Service. The attendees then spent the rest of the day serving as passionate advocates for their patients by meeting with their lawmakers and reporting back to ACP staff on where they stood on the College's priorities.

Late in the day, the Congressional Budget Office released its score on the impact of the bill passed by the House of Representatives, called the American Health Care Act, to repeal and replace the ACA. The CBO confirmed ACP's worst fears. If the AHCA or something like it passes Congress and is signed into law by President Trump, 23 million people could lose coverage, and typical deductibles and premiums likely would increase, especially for older and sicker patients. The CBO also found that one-sixth of the population lives in states that likely would seek waivers to rules requiring insurers to cover essential benefits and prohibiting them from charging more to people with preexisting conditions.

Thursday, May 25

A second ACP policy committee, the Medical Practice and Quality Committee, met to discuss ACP's efforts to reduce administrative tasks for physicians, to make electronic health records more useful and less burdensome, to advance physician-led alternative payment models, to improve Medicare's new Quality Payment Program (QPP), to create new codes and payments for internists' services, and to seek a study of the impact of any willing provider laws. The committee also reviewed a wide and growing range of services that ACP provides its members to help them with quality reporting, practice improvement, and transition to QPP and other value-based payment programs. A particular focus of the discussion was to help smaller and independent internal medicine practices succeed in the new models.

Also that day, a federal appeals court ruled that a court-ordered halt to President Trump's executive order on immigration, which would have limited or banned travel from six Muslim-majority countries, would remain in effect. This decision was in accord with ACP's concerns about the potential discriminatory impact of the order, especially on physicians and refugees from the affected countries.

All told, these four days represented the best of ACP: committed members taking time out of their busy lives to advocate for their patients and to develop policy on a range of issues affecting both patients and the profession. It also showed why such advocacy is especially important today, when coverage for millions, funding for essential health programs, and the principle of nondiscrimination based on religion are under challenge.