ACCP Testifies Before House Committee on Appropriations
On Wednesday, March 8, 2017, ACCP Associate Executive Director C. Edwin Webb, Pharm.D., MPH, FNAP, testified at a hearing in front of the House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.
The Appropriations Committee, together with its Senate counterpart, has jurisdiction over all government expenditures. The Subcommittee on Labor, Health and Human Services, and Education controls overall spending for the Department of Health and Human Services (HHS), including the entire Medicare program, the federal portion of the Medicaid program, and agencies including the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and National Institutes of Health (NIH).
In his testimony, Webb specifically urged the subcommittee to provide AHRQ with at least $334 million in budget authority, consistent with current fiscal-year levels. AHRQ is the only federal agency with the sole purpose of evaluating and disseminating research that determines how to make care as effective, efficient, and affordable as possible. AHRQ supports research and communication programs that are perfectly aligned with ACCP’s commitment to advancing a patient-centered, collaborative health care approach that delivers better care, smarter spending, and healthier people.
Webb went on the highlight the critical need to integrate coverage for comprehensive medication management (CMM) within the Medicare program as part of the overall effort to move all health care to a more value-based, collaborative, and efficient system.
The federal government is currently responsible for more than $1 trillion per year in health care spending, and mandatory programs (including Medicare) are projected to overwhelm the entire federal budget. Webb therefore urged the subcommittee to provide adequate resources to ensure that health care delivery organizations, health providers, policy-makers, and the people they serve make informed choices about how to obtain the best care while addressing costs and protecting patient safety.
As part of this effort, ACCP has called on Congress to take action to meaningfully address problems associated with suboptimal and inefficient medication use and truly help patients “get the medications right” by promoting and advancing coverage for CMM services delivered under collaborative, patient-centered payment and delivery structures.
Click here to view a video of Webb’s testimony.
Click here to read the written testimony in full.
ACA Repeal-Replace: Collapse of the American Health Care Act
H.R. 1628, the “American Health Care Act” (AHCA), released on March 6, 2017, was expected serve as the legislative vehicle through which Republicans would fulfill longstanding pledges to repeal and replace the Affordable Care Act (ACA), also known as Obamacare.
Instead, by the evening of March 24, House Speaker Paul Ryan (R-WI)—who had personally championed the legislation—canceled a planned vote on the bill and informed President Donald Trump that in the absence of Democratic support, his party lacked the votes necessary to pass the plan.
What Did the Republican Plan Look Like?
Central to the challenges facing the GOP was the fact that despite its political posturing, the AHCA would not have delivered a full repeal of the ACA. Certain key ACA provisions would have remained in place. In particular, the repeal bill retained several popular patient protections related to insurance coverage reform, such as the ACA’s requirements that health plans:
Central to the challenges facing the GOP was the fact that despite its political posturing, the AHCA would not have delivered a full repeal of the ACA. Certain key ACA provisions would have remained in place. In particular, the repeal bill retained several popular patient protections related to insurance coverage reform, such as the ACA’s requirements that health plans:
- Cover preexisting conditions.
- Guarantee availability and renewability of coverage.
- Cover adult children up to age 26.
- Cap out-of-pocket expenditures.
The bill would also have protected the ACA’s prohibitions against:
- Health status underwriting.
- Lifetime and annual limits.
- Discrimination on the basis of race, nationality, disability, age, or sex.
A Congressional Budget Office (CBO) analysis of the cost and social impact of the bill projected that if the AHCA were enacted, the number of uninsured would grow by 24 million by 2026 because of the elimination of the Medicaid expansion and the individual and employer coverage mandates. CBO found that the bill would reduce the budget deficit by $337 billion over 2017–2026, through cutting Medicaid by $880 billion and eliminating $673 billion in ACA subsidies. In addition, the agency found that the bill would reduce taxes by $883 billion. However, a large portion of these tax cuts would disproportionately benefit higher earners—almost $300 billion in savings would have applied only to individuals earning over $200,000 per year.
A Divided Republican Party
Immediately after the November 2016 elections, as Trump secured the presidency and the Republican Party retained control of both chambers of Congress, repeal of Obamacare seemed almost inevitable. On the campaign trail, Trump repeatedly stated that repeal was a top policy priority and a key reason he was running for president. Over the previous 6 years, congressional Republicans had voted to repeal President Barack Obama’s signature legislation on more than 50 occasions. Yet when presented with the opportunity to finally deliver on these promises, Republicans were unable to coalesce around a unified strategy to move forward.
Despite full control of Congress, Republicans are deeply divided over how to replace Obamacare while Democrats remain fully united in their opposition to the repeal. Ultimately, it was the refusal of the members of the conservative Republican Freedom Caucus to support the proposal that led to its demise, based on their belief that the bill would keep too much of Obamacare intact. But there was also widespread concern among more moderate Republicans that the AHCA would cause millions of Americans to lose health coverage without contributing in a truly significant way to deficit reduction.
At the same time, there were suggestions that Trump had blundered politically by putting pressure on Congress to fast-track passage of the legislation and issuing a “take-it-or-leave-it” ultimatum to the Freedom Caucus to support the AHCA or walk away. Members of the Freedom Caucus, in response, criticized the “binary choice” they faced in supporting either the AHCA or Obamacare.
What’s Next?
It’s clear that the collapse of the AHCA effort calls into question Trump’s reputation as a skillful negotiator and dealmaker and casts doubts over the congressional Republicans’ ability to build consensus within an ideologically divided party. But already, tentative discussions are emerging on Capitol Hill around legislative concepts that could possibly yield broad Republican support. Most Republicans will admit that strategically, mistakes were made in their approach to the repeal-and-replace process. Yet the party remains unequivocal in its opposition to Obamacare. As the White House acknowledges that the health care reform process is far more complicated than it anticipated, there is a glimmer of optimism that a renewed effort to replace Obamacare will be more thoughtful, consensus-driven, and even, possibly, bipartisan.
ACCP Board of Regents Approves Position Statement: “Optimizing Specialty Drug Use”
National spending on prescription medications has steadily—and significantly—increased. Although advanced science and technology have led to new therapies with tremendous promise, their associated cost to providers, patients, and payers in many cases limits access to these therapies across the spectrum of health care delivery. Moreover, specialty medications (i.e., medications with a total average cost greater than $1000 per prescription or an average daily cost greater than $33 per day) account for a disproportionate share of these costs.
The “right prescription for the right patient” has always reflected one of pharmacists’ fundamental commitments to their patients. However, its meaning must evolve to “getting the medications right” for all patients by incorporating a commitment to ensuring the selection of the right patients for such expensive therapies. Combining comprehensive medication management (CMM) with value-based pricing strategies promises more rational and economical use of specialty medications by optimizing their use for patients and health systems.
In response to this issue, the ACCP Board of Regents approved a new position statement, “Optimizing Specialty Drug Use,” in February during the 2017 Updates in Therapeutics® meeting in Jacksonville, Florida. This statement is intended to express ACCP’s position on optimal specialty drug use and to emphasize that CMM is necessary to achieve optimal specialty medication use in order to ensure the best possible outcomes for patients and the health care system.
Please review the pre-publication version of the statement and contribute to our dialogue about the importance of clinical pharmacists’ work in “getting the medications right” in the context of specialty drug use.
Click here to read the statement in full.
ACCP-PAC Contributions Support Bipartisan Health Care Leaders in Congress
The partisan divide in Washington has reached unprecedented levels. Amid this sometimes toxic political environment, ACCP is targeting true health care leaders from both parties who are willing to work with colleagues across the aisle to enact health care legislation focused on team-based, patient-centered care that measures and rewards quality and outcomes.
However, these moderate, bipartisan legislators will inevitably face primary challenges from the fringes of their parties. ACCP must provide support for such leaders in order to ensure they remain in Washington and continue to advance policies that meaningfully address the health care issues our nation currently faces.
With the Affordable Care Act (ACA) repeal and replace now under way and entitlement reform (including potentially significant changes to Medicare payment and delivery structure) on the horizon, a well-funded PAC is essential.
Only ACCP members are eligible to contribute to the PAC and allow us to make these vital political contributions. With its more than 18,000 ACCP members, ACCP is in a position to become one of the most prominent pharmacy PACs in Washington. To do this, we need the widespread support of our membership.
If each ACCP member contributed just $25, ACCP-PAC would raise over $350,000. All ACCP members should consider donating at least $25 to ACCP-PAC. CLICK HERE to support your PAC today!
Contact Us! For more information on any of ACCP’s advocacy efforts, please contact:
John K. McGlew
Director, Government Affairs
American College of Clinical Pharmacy
1455 Pennsylvania Avenue Northwest
Suite 400
Washington, DC 20004-1017
(202) 621-1820
[email protected]