Thursday, August 13, 2009

How ACP Determines Its Positions on Health Care Reform Legislation

Advocate Blog Guest Blogger: Jack Ginsburg, director of Policy Analysis and Research

Responding to legislation on behalf of ACP can be a daunting task. How does an organization of 129,000 members address legislative proposals for health care reform that are moving rapidly through Congress, whose provisions are complex and are being revised frequently, and on which ACP members may have differing or opposing views?

All five congressional committees with jurisdiction on health considered (and four passed) legislation in just a few months this year. Differences in legislation between the House and Senate will now need to be reconciled when Congress returns in September from its recess and then each chamber will consider passage of a final bill that could also include consideration of amendments. ACP has been involved at each stage in the process, seeking to assure that legislation is consistent with ACP policies and priorities.

ACP's involvement, however, began long before Congress considered any specific bill and will not end with a presidential signing ceremony. ACP also will need to respond to proposed rules and regulations that will be forthcoming to implement any provisions that are enacted. The process could be repeated again next year as further legislation is considered. Fortunately, ACP has a process for developing factual, evidence-based public policy positions that are representative of its members' views. These policy positions then serve as the basis for our legislative advocacy efforts. The process involves ACP membership, leadership, committee members, chapters, councils, and staff.

All of the health reform bills considered by Congress are comprehensive and complex, addressing a broad range of issues: health insurance reforms, access to care, physician payment, workforce, health care delivery, health professions loans and scholarships, prescription drug coverage - to name a few. ACP had extensive policy on most issues, but of course there were some new issues for which we did not have existing policy. For these, a fast-track process was employed to develop new policy. I'll explain how ACP responded to all of these health care reform proposals, but first let's quickly review how the College develops policy.

The process begins with the College's Strategic Plan. It sets forth ACP's high-level priorities, such as improving access to care and eliminating disparities. The objectives are developed by ACP's content-focused committees and its councils, which represent key member groups, with oversight by the Strategic Planning Committee and ultimate approval by the Board of Regents. Staff then develop programs to achieve these objectives. Governance and staff annually follow developments in the health care arena to adapt the College's positions.

The Health and Public Policy Committee (HPPC) develops ACP's positions on issues affecting the health care of the American public and the practice of internal medicine. Policy on payment and regulatory issues are developed by the Medical Services Committee (MSC), and ethics policies are developed by the Ethics, Professionalism and Human Rights Committee (EP&HRC). Membership on the committees includes a diverse mix of generalists and specialists, academics and private practitioners, ACP Regents and Governors, and representatives of ACP councils. Special attention is paid to assuring representation of all ACP members.

Development of public policy papers generally commence with ACP staff conducting a literature search and preparing background materials for the policy committee. Draft policy papers are then prepared for committee review and discussion. Following initial committee approval, a draft policy paper is circulated for comments to Governors, Regents, ACP chapters and/or their health policy committees, and the ACP councils representing subspecialists, students, residents and young physicians. Occasionally outside experts also are invited to review the confidential drafts. Comments and proposed revisions are then shared with the policy committee prior to submission of a final draft to the Board of Regents for final review and approval.

As Congress began consideration of health reform legislation in 2009, ACP was well prepared to provide its input to influence the legislation.

For the new issues for which we did not have existing policy, ACP's Health and Public Policy Committee responded by developing policy monographs on a public plan option, taxing employer-paid health insurance premiums, and mandating that all individuals obtain health insurance. The monographs were reviewed and approved by the committee within a very short timeframe and were then recommended for approval by the Executive Committee of the Board of Regents in June 2009, following review and discussion. The full Board of Regents reviewed and approved the three papers in July 2009.

In 2008, ACP prepared a proposal for legislation to improve the attractiveness of careers in primary care. Working with Congresswoman Allyson Schwartz (D-13th PA) and her staff, this proposal was introduced last fall and was eventually re-introduced in the new 111th Congress as the Preserving Patient Access to Primary Care Act (H.R. 2350) in May. Obtaining support for this legislation was a major objective of ACP's Leadership Day advocacy effort this year, and much of its provisions are now reflected in the proposed health care reform legislation. A companion bill was introduced in the Senate by Maria Cantwell (D-WA), S. 1174.

In March, then ACP President Jeffrey P. Harris, MD, MACP, presented testimony to the House Energy and Commerce Health Subcommittee.

Also in the spring, Senator Max Baucus (D-MT), chairman of the Senate Finance Committee, began issuing proposals for regarding health care reform. These proposals came in three waves. First, were proposals for delivery system reform, then options to improve quality, and finally financing options. ACP staff promptly reviewed each proposal and prepared side-by-side analyses with comparisons to ACP policies. The ACP policy committees then reviewed the proposals and the staff analyses. ACP's leadership was then briefed and approved the stances to be taken by ACP. Meanwhile, ACP lobbyists worked closely with staff of the key health committees to convey ACP priorities for health care reform legislation. In May, new ACP President Joseph Stubbs, MD, FACP, submitted ACP recommendations for reform to the Senate Finance Committee.

When the three House committees reported-out their 1,080-page bill, ACP staff thoroughly reviewed it and prepared another side-by-side analysis with comparisons to ACP policy. Similar to the process with Senate Finance, ACP comments on this bill were also approved by ACP leadership and conveyed to the appropriate congressional committees.

Similar review, analysis, and comments were prepared in July for the bill reported by the Senate Health, Education, Labor and Pensions Committee and will be prepared when the Senate Finance Committee issues its actual bill.

In each case, proposed health care reform legislation was thoroughly reviewed and compared to evidence-based ACP public policy positions that had been widely vetted prior to ACP supporting any piece of legislation. All letters of support were first reviewed by the respective ACP committees and approved by ACP leadership.

For each piece of legislation, ACP has only supported those provisions that are consistent with ACP policy and has clearly stated its concerns about those that are not. Some issues, such as Malpractice Liability Reform, which ACP strongly advocates, were not addressed by Congress, and have been raised by ACP and other medical organizations. Throughout the legislative session, ACP's lobbyists and its leadership have also worked directly with congressional staff, members of Congress, and the White House to improve proposals for health care reform and achieve affordable health insurance coverage for all Americans.


For more information on legislation and health care reform please view our set of frequently asked questions.


Steve Lucas said...

A very daunting task given the current environment and rate of change in the proposed legislation.

Steve Lucas

DrJHO7 said...

Jack, thanks for the overview which reflects alot of hard work on the part of ACP Staff and ACP administrative and medical leadership. This is a nice reference document for those who have not followed ACP's output on the health care reform journey, particularly with the links. ACP ensures that internal medicine's voice on behalf of physicians and their patients is at the table.

ryanjo said...

Thanks for the explanation of how ACP policy is developed. Unfortunately, ACP's specific comments supporting certain components of the House bill has left the public and even some ACP members with the impression that ACP supports this highly flawed piece of legislation.
As an ACP member, I would prefer if my organization would clearly state that it cannot support the bill in its present form unless and until critical changes are made.

Unknown said...

Please repeat the ACS response to Mr. Obama's erroneous statements:
ACS Statement
I hope the ACP and AMA will reconsider their hasty and ill-informed endorsement of Mr. Obama and his vaporware plan.

Unknown said...

The ACP and AMA should withdraw their apparently unqualified support of Mr. Obama's plan until Tort Reform is directly addressed and honestly debated.

Unknown said...

From the ACP FAQ section: "America’s Affordable Health Choices Act of 2009 (H.R. 3200) unfortunately does not include any medical liability reforms. (This may partly be due to the fact that the three committees that prepared the bill have no jurisdiction over liability reform.) While continuing to call for caps, ACP will also urge Congress and the White House to explore other models, such as health courts, to reduce the costs of defensive medicine."
This is not satisfactory. Poll the membership, take a vote, hold a referendum. Withdraw College support of this bill until tort reform is addressed and DO NOT make excuses for the Obama administration who are ramming it down our throats, having apparently co-opted our so-called leadership.

Unknown said...

My summary impression is that this is a blog well worth reading, perhaps the best one can find on this topic.