New year, new chances to advocate for physicians, patients

I joined the American College of Physicians in the Division of Governmental Affairs and Public Policy in August 2022. In just a few months, I have been gratified to see the role that ACP and our leaders play in important policy discussions and the impact that ACP has on policymaking. Examples of our leaders' engagement include ACP President Ryan D. Mire, MD, MACP, representing ACP in a meeting at the White House hosted by the surgeon general and White House COVID-19 response coordinator and Sue S. Bornstein, MD, MACP, Chair of the Board of Regents, speaking at the Second Medical Summit on Firearm Injury Prevention, which ACP cohosted with several other physician associations. Through their leadership and the work of so many others, ACP has made significant advances on many policies impacting internal medicine physicians and their patients.

It is also important to recognize the essential role that ACP played in several important health policy wins for physicians and their patients this past year. Legislation was signed into law in April that ensures stability for Medicare payments for telehealth services for more than five months after the federal COVID-19 public health emergency ends. ACP's long-standing advocacy to increase affordability of prescription drugs came to fruition with the enactment of the Inflation Reduction Act (IRA) in August 2022.

The entire internal medicine community should take note of some of the most impactful provisions in the IRA, which ACP has a long track record of supporting. It extends subsidies for individuals purchasing health coverage through Affordable Care Act marketplaces through 2025, keeping comprehensive coverage affordable for millions of Americans. Additionally, beginning in 2023, the out-of-pocket cost for insulin for Medicare beneficiaries is capped at $35 per month, cost-sharing for vaccines is eliminated for Medicare beneficiaries, and pharmaceutical companies are required to pay rebates if price increases exceed the rate of inflation. There are other significant prescription drug provisions, including Medicare prescription drug pricing negotiation and capping out-of-pocket costs for seniors under Medicare Part D, which will be phased in starting in 2024. The IRA also includes significant investments intended to combat climate change and pollution.

Another important public health win in 2022 is the Bipartisan Safer Communities Act, the first new law in decades designed to reduce firearms violence. Highlights of the law include support for enhanced background checks, elimination of the “boyfriend exception” from background checks for domestic abusers in a recent relationship, funding for “red flag” laws and other crisis intervention programs, and increased funding for mental health care and training of mental health clinicians.

Lastly, with physicians facing an array of payment cuts, Congress acted to stop most of these cuts from taking effect on Jan. 1. While the worst of the cuts were prevented, much more needs to be done to ensure that physician payment is sufficient to cover the cost of caring for patients.

The start of the new year provides an opportunity to pause to reflect on the past year and think about what lies ahead. For many of us this is true in both our personal and professional lives. The beginning of the year also marks the end of the 117th Congress and the beginning of the new 118th, so health care lobbyists and public policy professionals also take stock of what has been accomplished over the past year as well as unfinished business. We should be appreciative of the progress we've made and simultaneously mindful of the ongoing needs of physicians and patients that need to be addressed.

Even with important policy wins, much work is needed to support physicians' ability to care for their patients and access to evidence-based medical care for all Americans, when and where they need it. Over this past year, progress has been made to reform unnecessarily burdensome prior authorization requirements in states and through federal legislation and rulemaking; however, important legislation stalled before legislative sessions ended. While the IRA makes insulin more affordable for Medicare beneficiaries, diabetes patients with private insurance were left behind.

Additionally, there are myriad examples of government interference in the patient-physician relationship. The most notable, of course, is the Supreme Court's decision in Dobbs v. Jackson to overturn Roe v. Wade and allow states to outlaw abortion, and even potentially criminalize health care services.

As we begin 2023, we need to build on our previous work. While the list of health policy issues that ACP is tracking is long, there are a few areas that are expected to be particularly active in 2023:

• Congress needs to address well-known shortcomings of the Medicare Access and CHIP Reauthorization Act (MACRA) and draft legislation reforming the Medicare physician payment system.
• Coverage and payment policies for telehealth services need clarity and stability, requiring Congress to enact legislation that makes permanent the services currently covered under the COVID-19 public health emergency.
• In state legislatures and Congress, there are opportunities to reduce administrative burden for physicians that build on ACP's Patients Before Paperwork initiative, including legislation to reform prior authorization requirements.
• Continued engagement with lawmakers is needed on how to best incorporate policy solutions that strengthen health equity and facilitate greater access to behavioral health services as part of broader health policymaking.
• Across the country and in Washington, D.C., there are going to be a range of needs and opportunities this year for advocacy in support of the patient-physician relationship and protecting physicians' ability to provide evidence-based care without the fear of outside interference or threat of sanction.

Success on these issues, or any other, does not happen without lawmakers hearing from you, their constituents. I am a fervent believer in the impact that organized, personal outreach to lawmakers can have. Physicians are respected voices in every community and can play a vital role in educating their lawmakers on important issues. It is also important to know that you do not need to be a policy expert to be an effective advocate; you just need to be comfortable discussing your own experiences caring for patients.

Advocacy is not a spectator sport, and to paraphrase an old saying, 80% of success is showing up. It takes a multitude of voices, especially those represented by the elected officials we are trying to reach, to have an impact on policymaking. The old proverb that many hands make light work is true in advocacy. The more people who engage, and the more regular their engagement is, the easier and more impactful their efforts are. Fortunately, ACP has a growing number of health policy and advocacy resources. You can engage by visiting ACP's advocacy page online and by:

• Reading ACP Advocate, which is published and emailed to ACP members on a biweekly basis.
• Joining ACP's Advocates for Internal Medicine (AIM) Network, which provides participants with additional advocacy content and opportunities.
• Taking action through our new online Legislative Action Center and emailing your lawmakers.
• Participating in ACP chapter state lobby days as well as ACP's Leadership Day in Washington, D.C.
• Utilizing ACP issue briefs and toolkits for content on active issues.

You can also contact ACP staff to discuss other potential opportunities for engagement with your lawmakers.

There are a range of needs and opportunities at the start of a new legislative session. Connecting with newly elected lawmakers provides a multitude of benefits and opportunities, starting with introducing local physicians, their ACP chapters, and ACP as trusted resources on health policy issues. Additionally, any legislation that was not enacted into law at the end of 2022 needs to be reintroduced, regardless how many cosponsors a bill had or how close it came to final passage. This means that we need to start over soliciting cosponsors and advocating for legislation to be prioritized. All lawmakers, especially those who are newly elected, benefit from knowing how legislation impacts their constituents.

I hope you will take time to connect with your lawmakers this year. As highlighted above, there are a number of ways to engage, some of which take very little time, and any constructive outreach helps.