Improving health of patients, practice environment

Last month, I wrote in this column about ACP's success in stopping Congress from repealing and replacing the Affordable Care Act (ACA). Despite repeated “repeal and replace” votes, most of the ACA remains intact, including Medicaid expansion, premium subsidies, guaranteed annual essential benefits, and its prohibition on insurers charging more to people with preexisting conditions or capping annual and lifetime benefits.

It's not that the ACA has survived unharmed: Congress' decision to repeal the requirement that people buy insurance, coupled with the administration's efforts to limit Medicaid eligibility and allow sale of policies that lack many of the ACA's consumer protections, has resulted in higher premiums and a recent uptick in the number of uninsured. Still, that the ACA has survived at all is a testament to the effectiveness of ACP advocacy, and that of many others, on behalf of patients.

Yet ACP's advocacy is about much more than the ACA. Recently, ACP's communications staff posted on the College website a wonderful infographic about the College's advocacy achievements in 2017. It demonstrates both the breadth and effectiveness of ACP advocacy, from improving payments to internists' services, to reducing administrative tasks imposed on them, to blocking insurance mergers, to streamlining Medicare's Quality Payment Program, and much more. There are several advocacy wins that are particularly noteworthy (including a few not mentioned in the infographic):

Health care tax deductions. ACP achieved several big wins in the tax legislation that passed Congress in late December: For example, the deductibility of student loans and medical expenses was preserved, even though an earlier version of the bill passed by the House of Representatives would have repealed both.

Insurer mergers. The courts blocked two huge insurer mergers that would have reduced competition and harmed physicians and patients. ACP was directly consulted by the Department of Justice as it prepared its case to block the mergers.

Nondiscrimination. The courts stepped in to block the administration's ban on transgender persons serving in the military, consistent with ACP's opposition to the ban.

Immigration. Court decisions have also resulted in the administration substantially modifying its original executive order on immigration in a way that, while still concerning, is less damaging to the ability of physicians trained in the affected countries to enter and remain in the U.S. under legal visas.

Paperwork. ACP was able to advance its Patients Before Paperwork agenda to the point where the administration has launched a similar initiative, called Patients Over Paperwork, to reduce administrative tasks imposed on patients and their doctors.

Quality payments. ACP achieved substantial wins in improving the Medicare Quality Payment Program and payment for internists' services, particularly by easing the burden on smaller practices. Louis A. Friedman, DO, FACP, was invited by both the Republican majority and Democratic minority leadership to testify about his experiences with the Comprehensive Primary Care Plus model before the U.S. House of Representatives' Energy and Commerce Health Subcommittee—a testament to the high regard in which both parties hold ACP when it comes to payment and delivery system reforms.

Opioid crisis. The President's Commission on Combating Drug Addiction and the Opioid Crisis issued a report that is largely consistent with ACP's recommendations, including a recommendation to establish drug courts in all jurisdictions.

Prescription drug pricing. The National Academy of Medicine issued a report on prescription drug pricing that also closely reflected ACP's recommendations, and several ACP-supported bills were introduced in Congress to address the high cost of prescription drugs.

Climate change. While the administration's approach to climate change remains very concerning, states, localities, and businesses have stepped up to adopt measures to mitigate climate change and its effects.

Firearms. ACP and its Florida chapter had a big win when a federal appeals court overturned a Florida law that prohibited physicians from discussing gun safety with patients. Many states and localities have stepped in to adopt policies consistent with ACP's recommendations, by expanding background checks and other commonsense regulations while beating back the gun lobbies' efforts to make guns even more available.

Looking ahead to the rest of 2018, ACP advocacy will continue to be about improving the health of patients and the practice environment for internists. We will vigorously oppose efforts, whether by regulation or legislation, that will undermine coverage for millions of patients, including opposing the administration's recent decision to allow states to impose work requirements and other administrative barriers on patients enrolling in Medicaid. We will seek to have the federal government put its money where its mouth is by appropriating sufficient dollars to fund responses to the opioid epidemic. We will aim to streamline, reduce, and harmonize quality measures for public reporting and physician payment purposes, and to ease other administrative tasks imposed on doctors and patients alike.

We will advocate for enactment of bipartisan legislation to reduce prescription drug costs. We will continue to oppose discrimination, especially in access to health care and immigration policies, based on gender and gender identity, race, ethnicity, sexual orientation, and other personal characteristics. We will urge Congress and the administration to reach agreement on a pathway to protect Dreamers—young immigrant adults brought unlawfully to the U.S. as children—from deportation and to provide them with a pathway to citizenship, including the dozens who are enrolled in U.S. medical schools or physician residency training programs. And we will continue to advocate for measures to address firearms violence and climate change, two of the greatest dangers to individual and population health.

The defining feature of ACP advocacy is that it is all about improving the health of patients and the practice environment for internists, not one over the other, since both are necessary to create a health care system that serves patients and doctors alike. While there is much that has been accomplished to date, there is so much more that needs to be done by ACP to improve access, coverage, and health for patients, and to make it easier for internists to provide their patients with the care they need.