Washington Perspective


9-lives Obamacare survives zombie repeal

An attempt to repeal the Affordable Care Act failed, but continued vigilance is required, since zombies don't easily die, and Congress could try again.

Four days in May

Leadership Day on Capitol Hill, when more than 400 ACP members met with their senators and representatives to advocate for College priorities, occurred against a backdrop of historic events.

ACP's ‘big tent’ advocacy agenda

ACP's advocacy on legislative and regulatory issues extends beyond partisan political debates and is meant to help physicians in their pursuit of clinical care.

What now for health care reform after a first try fails?

ACP's lobbying agenda includes working on a bipartisan basis to shore up health insurance markets, give people more choices of coverage, and protect coverage for the most vulnerable covered by Medicaid.

ACP engages in the political process because it is necessary

There is almost nothing that physicians and the larger health care system can do for patients that isn't affected by what comes down from Washington. ACP must become involved in the political process.

‘Facts are stubborn things' and are needed more than ever

ACP advocacy is based on the premise that public policy positions that are well supported by facts and evidence will be more persuasive and have greater acceptance.

Who loses if Obamacare is repealed? Just about everyone

Republican congressional leaders are beginning the process of enacting legislation to repeal the Affordable Care Act (ACA) in stages, using a process that has been called repeal, delay, and replace.

What the Trump administration can learn from Obama

The idea that the GOP can come up with a quick and easy plan to replace the ACA is just not realistic. It is going to be a hard slog, not a sprint.

Health policy after the election

The 2016 elections will have huge consequences for health policy.

ACP to small practices: We've got your back

Internists in small practices worry that the payment disruptions from the Medicare Access and CHIP Reauthorization Act (MACRA) will be the straw that breaks the camel's back for profitability. ACP is committed to ensuring that this doesn't happen.

Making MACRA better, in intent and implementation

The Medicare Access and CHIP Reauthorization Act makes significant improvements in how Medicare links payment to reporting of quality measures. Will CMS actually implement the law in a way that truly simplifies reporting?

Setting the record straight on MACRA

There is a growing awareness among physicians that the Medicare Access and CHIP Reauthorization Act (MACRA) makes important changes in how Medicare will reimburse them, as well as confusion about what will be different and what they should do to be ready.

CMS charts the way to a new Medicare payment system

Medicare is transitioning to a new value-based payment system, and the agency has outlined specifics about how it intends to implement it.

ACP's prescription for rising drug costs

ACP has 4 concrete proposals to address rising prescription drug prices: regulating and negotiating prices, enhancing transparency, increasing competition, and considering value.

Defining value and creating quality in the patient encounter

Critical questions will arise about defining and measuring value in the patient encounter when the Medicare Access and CHIP Reauthorization Act goes into action.

From policy to results: How does it all come together?

The process by which advocacy organizations achieve results for their members can seem opaque to those who are not directly involved. How does advocacy really work?

Merger mania, merger blues

ACP will continue to press federal and state regulators to block recently proposed insurance mergers, which may decrease choice and increase costs for patients and employers, reduce access due to changing and narrowing networks of physicians and hospitals, or prevent physicians from negotiation over provision of health services.

Must telemedicine disrupt the patient-doctor relationship?

Telemedicine will be highly disruptive to patients and physicians. Like other technological advances, such disruption can be a good thing, leading to improvements in patient care. It can also be disruptive in a bad way if it undermines that patient-physician relationship.

How's Obamacare doing in getting people covered?

With the Affordable Care Act in the midst of its third annual open enrollment period, more people are insured and most enrollees like their coverage. But now, it may be getting harder to sign people up.

How do physicians really feel about health care today?

Despite grumblings on social media, physicians are upbeat on the topics of health information technology, value-based payments, and the Affordable Care Act.

ACP advocacy is on a roll

ACP has scored major victories in Medicare's proposal to pay for advance care planning, a grace period for converting to ICD-10 coding, and access to affordable coverage.

How was ACP's 2015 Leadership Day different from all others?

Following the repeal of the sustainable growth rate, ACP seeks to secure its future through other legislative and regulatory goals, including physician payment reform, graduate medical education, and primary care workforce programs.

With SGR dead and buried, what's next for ACP advocacy?

Removing the sustainable growth rate formula frees up physician advocacy organizations to talk to Congress about other important issues that otherwise would have been overshadowed, such as the Primary Care Incentive Payment Program.

How Medicare fee-for-service is like a 1965 Ford Mustang

Fee-for-service reimbursement is a half-century old, and despite its staying power is now facing demands that it be modernized, if not traded in altogether.

A taxing season for Obamacare

April's tax filings may create sticker shock among the electorate, testing whether the gains in health care access made by millions of people can be sustained.

Does ACA coverage really make a difference?

Patients with health insurance have better outcomes and enjoy better quality of life. The Affordable Care Act is offering more people access, even though cost-sharing may still put better care out of reach.

How will the new Congress affect ACP's priorities?

ACP outlines its legislative agenda for the year, including resisting changes to the Affordable Care Act, preserving the Medicare primary care bonus program, and repealing the Medicare sustainable growth rate.

What do we know about Obamacare's enrollees?

Based on Obamacare's year 1 enrollment numbers, the law has been very successful in bringing down the numbers and percentages of people without health insurance. But these data also show why it struggles to win support among the broader public.

Putting patients before paperwork, and playing Whack-a-Mole

ACP has decided to once again take on the problem of excessive paperwork and other administrative burdens, including those imposed by the advent of electronic health records.

Government dysfunction: It's enough to make a grown man cry

A host of issues highlight the dysfunctional approach that federal and state governments have taken toward issues with a direct impact on health care.

Home sweet medical home

Patient-centered medical homes work because they incorporate best practices, pay internists for coordinating care, and ensure accountability in achieving healthy outcomes. Results from early adopters are showing positive results.

When will Medicaid begin to get the respect it deserves?

Medicaid is the largest provider of government-funded health coverage in the United States, based on number of people enrolled, yet it doesn't get as much attention as Medicare. That may soon change.

Did the Affordable Care Act make the grade?

Four years since health care reform became law, there is finally enough information to grade how well enrollment is going. It will be many more years before the program can be judged an overall success, however.

Four things that would improve the Affordable Care Act

After reflection on the first year of health care reform, and the conclusion of the first enrollment period, 4 aspects could make the program work even better.

What did 11 years, 16 patches and $154 billion get us? Nothing

There are plenty of examples of wasteful government spending, but the sustainable growth rate formula is hard to top.

Transparency needed for successful health care reform

Access to health care can collide with controlling costs. Balance, transparency and real choice will help not only the success of the Affordable Care Act, but Medicare Advantage and employer-based health plans.

Why 2014 may be a make-or-break year for health reform

2014 is shaping up to be a critically important year in determining whether the country moves forward or backward on expanding health insurance to 30 million uninsured persons and providing better consumer protections for many millions more.

Health reform's winners and losers: by the numbers

Breaking down the numbers offers insight into who stands to gain the most from the reforms provided by the Affordable Care Act. But the broader coverage offered under the law means that the country as a whole is better off.

Five questions that may decide success of health care reform

As open enrollment begins under the Affordable Care Act, its success depends upon who signs up, how easy it is to do so, and whether the states help their residents do so. Physicians can help their patients sign up.

ACP can help members, patients access insurance options

Health care reform has reached its implementation stage, and internists will now face new patients with new questions about how to access health care.

Will U.S. physicians swim or sink in changing health care waters?

Health care reform, pricing transparency and the movement away from fee-for-service payments mean the times are changing for American medicine.

ACP's Washington office reviews its own 'seven days in May'

A recent week provides a great example of how ACP's Washington office supports College advocacy.

Firearms vote shows the worst of Washington politics

Washington, D.C., politics has become so dysfunctional that the federal government is no longer capable of solving great problems such as firearms-related injuries and deaths, the federal deficit and debt fueled by unsustainable health care spending.

Sequestration's cutbacks could cause patients serious harm

As sequestration's impact on health care looms, physicians must tell members of Congress reach a bipartisan agreement with the president to reduce spending on less effective and lower-priority programs, increase funding for more important and more effective programs, and further trim health care spending by focusing on unnecessary care.

Transparency needed for successful health care reform

With fewer than 10 months left until the Affordable Care Act's coverage guarantees take effect, how prepared are federal agencies and state governments to make the law work?

Transparency needed for successful health care reform

Physician silence on gun control puts children and adults at risk from a person using firearms to harm them, in their classrooms, in their own homes, in their workplaces and on their neighborhood streets.

Tallying the fiscal cliff's winners and losers in health care

Congress avoided big tax increases and across-the-board spending cuts—barely. ACP examines who won and who lost in health care.

Addressing dissatisfaction in internists' day-to-day practice

As a direct result of ACP's advocacy efforts, internists will see higher Medicare and Medicaid payments and relief from intrusive administrative requirements.

Spending on physician services, take two

Reform is required in how physicians are paid, including a more rigorous analysis of the relative value of services and compensation for the cognitive work done outside of the patient encounter.

2012 election to decide four critical health care questions

Medicaid, Medicare, funding for medical education and guarantees of health insurance coverage for all Americans are on the line in the upcoming presidential election.

States' stances on health reform reflect political, moral choices

Now that health care reform is established at a national level, the battle moves to the states that choose to accept or reject establishment of health care exchanges and federal funding for Medicaid.

Positions on health care reform aren't all black and white

ACP's health care positions can't be neatly labeled as coming from one political perspective or another. A wide array of issues requires consideration.

Does the United States pay its doctors and hospitals too much?

The United States won't control health care costs until it addresses the excessive prices it pays for some health care services.

States eye health care reform if federal law is overturned

The Supreme Court is ruling on the constitutionality of health care reform, leaving states in the position of having to plan for any eventuality. Letting the states take the lead in health care reform remains a viable option.

Haggling over health care reform is like a children's game

Health care reform has made progress with internists already seeing bonus reimbursement in their offices. But the Affordable Care Act is about to run smack into the Supreme Court, and what happens there could result in any range of outcomes.

What is the state of American health care in this election year?

ACP's annual report on the state of health care cites proposed budget cuts as the biggest threat to recent advances made by health care reform. And more advances could be affected by the outcome of the presidential elections.

What can the audience expect from Congress' second act?

Congress' dysfunction has led to record-low approval ratings of 11%, and continued delays in resolving issues important to physicians, such as reimbursement and medical education.

Super fail: Congress sets new low for ineffectiveness

An attempt at political compromise failed, even when the consequences were so sever as to guarantee some type of success. The pressure will only increase in an election year, threatening physician payments, cuts to critical health programs and services, and no end in sight for a solution.

What should physicians contribute to deficit reduction?

ACP has proposed that Congress create a national, physician-led initiative to promote high-value care, promote research into comparative effectiveness, and reduce the needless expense of defensive medicine.

Mandated health care cuts don't equal health care reform

Under the new budget control agreement that President Obama and Congress reached in August to allow for an increase in the debt ceiling, federal health care spending could be subject to deep cuts.

Debt deal could hurt programs crucial to internal medicine

Politicians often choose to wait until the absolute last minute to strike a deal on difficult decisions.

When will the lights go out on fee-for-service?

Physicians have been paid according to the number of visits or procedures they bill for a very long time, almost half a century for Medicare.

Is this the end of Medicare and Medicaid as we know them?

President Obama and House Republicans have issued starkly different proposals on the future of Medicare and Medicaid.

Health care reform gets mixed reviews one year later

It's been a little over one year since the Affordable Care Act was signed into law by President Obama. How is it faring?

Budget brinkmanship may yet impact health care reform

An election is held. The political party that promised to change the direction of American politics wins a lopsided victory.

'Rationing' charge prevents real discourse on health care costs

Critics have unfairly attacked health care reform. But proponents haven't been straightforward about its costs. The truth involves how resources get allocated.

History will judge outgoing Congress' impact on health reform

One would have to go back more than 45 years to find a Congress that has had as big an impact on health care as the just-departed 111th Congress.

Influencing the details of health reform so internists get paid

It is often said that people don't see the forest for the trees, obsessing on the details instead of the big picture.

Would Congress cut funding for popular health care programs?

A serious bi-partisan discussion is needed to make serious decisions about health care reform.

Health care reform, PCMHs forge a new path for primary care

A new focus by health care reform advocates on the patient-centered medical home will forge a path toward financing and delivering primary care.

Monday morning quarterbacking doesn't score touchdowns

The "failure" to permanently reform the sustainable growth rate formula shouldn't jeopardize overall progress on health care reform.

Changing health care from the ground up

Health care reform will play out in doctors' offices, not in Washington, D.C. Patients and physicians will determine how costs change in the upcoming years.

Now begin the nuts and bolts of health care reform

The American College of Physicians begins an educational campaign to introduce health care reform to its members.

Health reform could improve the lives of patients, internists

Health reform legislation represents a historic shift in the federal government's role in health care, but debate continues whether it will be good for America and for internal medicine.

Change fee for service to another method that reflects quality

Fee-for-service payments need to align incentives with value of services rendered.

Medicare could stay solvent if stakeholders act soon

Congress faces unpopular options as they consider how to stay solvent through this decade and the next.

Even with new legislation, health care reform would evolve

Every Congress has made its mark on Medicare since the program's inception in 1965. Success or failure for health care reform isn't the end of the journey, but another milestone.

Political perils of cost control complicate health care reform

Even if health reform passes, the problem of rising costs will not go away. And politicians cannot confront the fundamental issue that Americans can't have all the health care they want.

Affordable health care puts individuals, society at odds

The public would have more confidence in the cost-control measures that emerge from health care reform if physicians led the discussion.

Finding common ground when some gain and others lose

Proposals that redistribute money pose a special challenge to physician membership organizations. Physicians expect their societies to represent their interests, but what happens when one subset of members stands to benefit at another's expense? ACP chooses a path that's best for patients.

Health care reform at the precipice: What happens next?

A snapshot of health care reform as Congress takes a mid-summer break. Multiple bills need to be reconciled, while members of Congress face increasing pressure from advertising and lobbying.

Three keys to health care reform: change, buy-in and unity

Politicians acknowledge needing more primary care physicians, but paying for it requires support from elected officials and from the College.

Primary care gains ground but pay reform still up in the air

Politicians acknowledge needing more primary care physicians, but paying for it requires support from elected officials and from the College.

Can Obama team navigate rough waters of health reform?

A large number of Americans favor health care reform, which could help the new President as he seeks to overcome mandates, taxes and pay cuts.

Stimulus package part of down payment on health reform

Stimulus legislation enacted in the first two months of President Obama's administration show that the White House is serious about health care reform.

What do Obama's first weeks tell us about health care reform?

Searching the first 100 days of President Barack Obama's administration for clues about health care reform.

Getting back to basics: reform care at the doctor-patient level

President Barack Obama and Congress is a return to basics, a recognition that the relationship between patients and their primary care doctor is the basis of all good medical care. But reform will also require funding.

Will President-elect Obama achieve true health care reform?

Four good reasons why President-elect Barack Obama may succeed in reforming health care.

What will it take to fix the broken reimbursement system?

Align physician reimbursement to compensate for the best possible patient care coordination.

The 'central fiscal challenge' the candidates aren't discussing

None of the presidential candidates are discussing health care cost containment, setting up reform as an issue doomed to fail after the election.

What this year's Medicare battle portends for health care

The Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) was a huge victory for ACP and its allies.

A passion for primary care and politics at Internal Medicine

Internists often ask me what it will take to restore primary care in the U.S. Even more important than policies, strategies or tactics is having the passion to create great change.

Progress creates pushback as ACP moves ahead on reform

Recent events show how much progress we are making, and the growing level of controversy that has resulted.

ACP's widely cited paper on universal access grew out of intensive policy development process

Achieving consensus on complicated policy issues to produce meaningful, evidence-based policy presents a significant challenge for large membership organizations like ACP.

Will the 2008 elections be the turning point for health care?

For the first time in 15 years, health care reform is back as a major campaign issue.

Democrats overplay their hand on health care policy

The newly elected Democratic majority that took charge of Congress last January promised an ambitious health care agenda.

Congress needs to rewrite script for fixing payment system

Washington, D.C. is once again playing its own version of the film "Groundhog Day."