Wednesday, December 7, 2016

Preparing ACP for the post-election political environment

It’s often said that elections have consequences, and this is especially true of the 2016 election. The election of Donald S. Trump, combined with continued GOP control of Congress, will rock the health care world, starting with the GOP pledge to begin to repeal and replace the Affordable Care Act early in the new Congress. 

But it’s not just the ACA: the Trump administration may try to privatize the VA, end U.S. commitments to reduce emissions contributing to climate change, reverse Obama’s executive actions on firearms violence prevention, convert Medicare into a defined contribution (voucher) program rather than an open-ended entitlement, and much, much more.  While these are highly concerning to ACP, we believe that there will be many opportunities to find common ground on improving access to mental health, healing the opioids epidemic, reducing barriers to chronic care management, reforming the medical liability system, and especially, reducing regulatory burdens on physicians and their patients.

In order for ACP to be effective, we have to start by stepping back and assessing what the impact of the elections will likely be on our priorities, recalibrating as needed to achieve our objectives.  To be clear, this does not mean stepping back on our commitment to issues like universal coverage, mitigating the public health impacts of climate change, reducing gun violence, and ensuring access to care for all persons without regard to race, religion, ethnicity, gender and gender identity, and sexual orientation; these are overarching core principles and policy commitments the College has made to the public, they can’t be negotiated away.  But we can and will assess how best to advance or defend them given the changed political circumstances.

Here is what your ACP advocacy team in Washington has been doing to help ACP prepare for the new administration and Congress:
  • We provided suggestions to ACP President Dr. Nitin S. Damle on his November 17 email to all ACP members, U.S. and international, on the implications of the 2016 election.
  • We are working with Dr. Damle on responding to several dozen e-mails from members in response to his letter.
  • We are doing a comprehensive staff assessment of all of our key public policy priorities; for each of them, we are evaluating whether there is a threat or opportunity or threat and opportunity, whether it’s from Congress, the Executive Branch, or both; and whether we need new or revised policy direction from the ACP policy committees, regents and governors.
  • In particular, we are examining how the GOP may use a “repeal, delay, and replace” legislative strategy to undo as much of the ACA as possible through budget reconciliation, which requires a simple majority vote, while delaying for a couple of years the date(s) when those provisions would expire, which in theory gives them a time to develop a replacement plan (which is much easier said than done, which I will address in a future post).
  • For some of our priorities, we are doing a much deeper policy dive; for instance, examining possible GOP alternatives to the ACA overall and specific elements of it; the impact of possible efforts to privatize the VA system; implications of turning Medicaid into a block grant program; potential threats to Graduate Medical Education funding; and policies affecting women’s health access, among others.
  • Our regulatory affairs team is preparing specific recommendations to the new administration and Congress on changes in federal regulations, quality measurement, EHRs and “meaningful use” requirements, documentation guidelines, and on other ways to ease administrative burdens on physicians.
  • We are reaching out to other health-advocacy organizations, not just within the medical profession, but with business leaders, hospitals, insurers, and consumer groups, to see where our interest may align and where we may differ; and how we might work together when we are in agreement.
  • We are continuing to encourage members to sign up to participate in our grass roots Advocates for Internal Medicine (AIMn) program while making enhancements to it.  The strength of this program will to a large extent determine how effective we can be advocating with the new Congress.

Even as we are devoting so much of our time to prepare for the new administration and Congress, we are ensuring that ACP’s voice is heard now, as the lame-duck 114th Congress completes work on several outstanding health care bills, including the CURES Act and a temporary resolution to fund the federal government into early next year.  We are also providing extensive comments to the outgoing Obama administration on the 2017 Medicare physician fee schedule final rule and the MACRA final rule.  Oh, and we are developing new and updated resources and tools to help members be successful as Medicare’s new Quality Payment Program (created by MACRA) begins to be rolled out on January 1. 

In my view, ACP advocacy is more important now than ever before.  On issues ranging from ensuring  that internists’ patients don’t lose their health insurance coverage, easing the regulatory burden on physicians,  protecting GME from budget cuts, ensuring that women don’t lose access to care, supporting the many ACP members in the VA system and the veterans they serve from ill-advised “reforms’,  advocating for medical liability reforms,  opposing policies that would be discriminatory against LGBTQ persons, and continuing to advocate for policies to reduce the health consequences of climate change,  ACP will be there, ensuring that internists’ voices are heard in this tumultuous time for American (and global) health care. 

Today’s question: What policies do you think are most important for ACP to advocate with the new Trump administration and Congress?

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