Despite the odds being stacked against anything getting done, ACP was able to achieve major advocacy wins in 2019.
Our achievements included persuading CMS to reverse its decision to pay a flat fee for office visits, regardless of their complexity. Instead, CMS finalized the biggest increases in payments for visit codes and other cognitive services ever. These changes will shift $7 billion to office visits and complex care management codes, the bread and butter of internal medicine specialists. The changes were finalized in the 2019 Medicare Physician Fee Schedule Final Rule but will not go into effect until Jan. 1, 2021.
Other wins included Congress enacting legislation to dedicate $25 million for the CDC and NIH to conduct research on reducing injuries and deaths from firearms, the first time in decades that Congress agreed to fund such research. ACP helped persuade federal judges to block Medicaid work requirements in several states because of the adverse impact they will have on the health of low-income patients. ACP joined in amicus briefs to block state laws to restrict women's access to reproductive services.
We helped get bipartisan legislation passed and signed into law by President Trump to stop prescription drug companies from imposing barriers to generic manufacturers obtaining the samples needed to create generic versions of brand-name drugs. ACP recommended and Congress agreed to pass a law to raise the age of purchase of tobacco products to 21. ACP advocacy also contributed to Congress' decision to halt the Pentagon's efforts to reduce the number of military medical billets (military graduate medical education training slots) by almost 18,000 until an assessment is conducted of the impact.
This is just a partial list. ACP has created an infographic with links to more information on our advocacy wins. (When I say “we,” I mean that ACP often led and at least contributed substantially to advocacy on these issues. As with all successful advocacy, we joined forces with like-minded organizations to grow our influence.) What's remarkable is that we got all of this done despite huge obstacles: Control of Congress and the White House is split between Democrats and Republicans; the overall political environment is as toxic and partisan as ever, especially with the rancor over impeachment; and everyone in Washington is looking to the 2020 presidential and congressional elections. Yet somehow, many good things for internists and their patients were accomplished on a bipartisan basis.
There is much more that needs to be done to improve the daily lives and professional development of ACP members and the health of their patients. Yet the political obstacles will be even greater in 2020, if that's possible to imagine.
In presidential election years, Congress' motivation is to do as little as possible, especially when control of the chambers is split. Democrats won't want to pass anything that could help President Trump's re-election or hinder their chances to retain control of the House of Representatives and take control of the Senate after the November election. Republicans will block any legislation passed by the House that could undermine the president's re-election or their chances of retaining control of the Senate. The partisanship and vitriol will be worse than ever.
By July, if not earlier, we will know the Democratic candidate for president. One thing for certain is that person will champion a fundamentally different approach to health care policy than President Trump. It won't be until after all the votes are counted in the November election that we'll know where health care policy will be headed for the remainder of this year and beyond.
Still, ACP has an opportunity to build upon our 2019 successes and continue to advance policies to help internists and their patients. Bipartisan legislation, called the Lower Health Care Costs (LHCC) Act, was agreed to by the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor and Pensions late in 2019 that includes many ACP-supported policies. The LHCC Act:
- authorizes a national campaign to increase awareness and knowledge of the safety and effectiveness of vaccines and to combat misinformation,
- provides funding for programs to reduce maternal mortality,
- funds programs to reduce and prevent health care discrimination, including training of clinicians on implicit and explicit biases,
- prohibits pharmacy benefit managers (PBMs) from charging a plan sponsor, health insurance plan, or patient more for a drug than the PBM paid the pharmacy for the drug and requires PBMs to pass on 100% of any rebates or discounts to the plan sponsor,
- strengthens enforcement of and compliance with mental health parity coverage requirements, and
- ensures continuation of mandatory funding for community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program for five more years.
Despite the bipartisan, bicameral support for such policies, the bill's fate depends on Congress reaching agreement on the contentious issue of surprise medical bills. The LHCC Act holds patients harmless for out-of-network surprise bills, which ACP supports. But it also benchmarks payments for out-of-network services to median in-network rates. ACP is concerned that such benchmarking would empower insurers to essentially set rates for all clinicians at the current median in-network rates. While the bill includes a process to appeal to independent arbitrators if a clinician and the insurer disagree on appropriate payments for out-of-network services, it allows arbitration only for bills above a high dollar threshold and limits how many can be sent to arbitration during a period of time. ACP is urging Congress to substantially improve the surprise billing provisions while advancing the many policies in the LHCC Act that we support.
Finally, ACP recently proposed far-reaching, connected, and comprehensive reforms to make health care better for everyone, which we are calling “Better Is Possible: ACP's Vision for the U.S. Health Care System.” This vision will set the stage not only for ACP advocacy in 2020 but for the rest of the new decade. Because ACP will be challenging a status quo that is failing so many, this plan will create controversy and opposition as well as support. Yet as ACP has shown so many times before, we don't let the politics of today stop us from imagining and advocating for policies to improve health care, no matter the odds.