Health Care Reform Fall Overview – What We Learned Over the Summer
On Tuesday, September 8, Congress returned to Washington after the August recess (or summer district work period, to use the official name for this period on the congressional calendar).
When Congress adjourned last July, it was with a sense of cautious accomplishment. Despite failing to meet the President’s target of passing health care reform legislation before August, four of the five relevant congressional committees had produced legislation that should eventually be considered on the floor of the appropriate chamber.
The House Energy and Commerce Committee, in particular, was widely praised for returning from the brink of a complete breakdown in negotiations to find middle ground that appeased the fiscally conservative blue dog coalition.
However, the summer recess took its toll on public and congressional support for the contentious health care overhaul.
Rational debate at Town Hall meetings was pushed to the sidelines as ideologues from the fringes of both political parties dominated proceedings. Specific details about the reform proposals were lost amid fears about socialized medicine and “death panels.”
Indeed, the ill feelings even spilled over onto the floor of the House chamber itself, when Congressman Wilson (R-SC) infamously shouted, “You lie!” at the President as he addressed a joint session of Congress.
Protecting the Strengths of Our System
Amid all the outrage, the need to reform our health care system remains as urgent as ever.
Simply put, U.S. health care spending currently accounts for more than 15% of the national gross domestic product (GDP), 40 million Americans remain uninsured, and the unfunded liabilities of Medicare and Medicaid threaten to overwhelm state and federal budgets. Few would argue that the status quo is sustainable over time.
Despite the well-documented flaws in our system, there is much to protect and enhance within the U.S. health delivery system. The United States leads the world in cancer survival rates, for example,1 and our system does not have the same problems with waiting lists and rationing as are inherent in other systems.2
The direction in which this reform effort should lead us as a nation is the great, unresolved issue. The country remains ideologically divided over the future role of the federal government in delivering health care, the cost of the controversial public plan option, and the potential impact of health care reform on the long-term viability of the private, employer-sponsored health insurance market.
Comparisons with 1993
Comparisons of President Obama’s campaign to reform health care with President Clinton’s failed effort are perhaps inevitable. In both cases, young, inspirational leaders made the issue a centerpiece of their election campaign and pushed hard for reform from the outset of their presidency.
However, President Clinton, on the one hand, was criticized for showing too much leadership on the issue – trying to force his proposal through a reluctant Congress and tasking the always-controversial then–First Lady Hillary Clinton with selling the plan to a skeptical public.
President Obama, on the other hand, ironically has received criticism of late for his failure to show leadership on the issue; his hands-off approach has received comment, leaving the committees in Congress and the congressional leadership to develop legislation. Indeed, the President hoped to avoid overly politicizing this lightning rod issue. However, as the summer progressed and the rhetoric in the media from proponents and opponents alike became more and more frenzied, the President came under fire for his lack of leadership and for letting the issue become defined by extremists.
Obama’s speech on September 9 demonstrated that the White House is attempting to regain some of its leadership and credibility on the issue, better defining its own vision for reform.
Progress So Far
Given the controversy surrounding this issue and the extent to which health care and the economy are intrinsically linked, the progress made in the first 6 months of the 111th Congress is remarkable.
Legislatively, the health care reform process is complicated by the cross-jurisdictional nature of the issue itself. Two committees in the U.S. Senate – the Health, Education, Labor and Pensions (H.E.L.P.) Committee and the Finance Committee – have oversight on portions of the reform process and have each drafted legislative language. On the House side, three committees – Energy and Commerce, Ways and Means, and Education and Labor – share responsibility.
Committee Update
- At press time, the Senate HELP Committee, House Ways and Means Committee, House Energy and Commerce Committee, and House Education and Labor Committee had each approved separate pieces of legislation, which will eventually be considered on the floor of the appropriate chamber.
- The hugely influential Senate Finance Committee, which controls all health programs under the Social Security Act and health programs financed by a specific tax or trust fund, was an early leader in releasing discussion documents and legislative talking points. However, this committee has reached an impasse in negotiations and has not held hearings on the issue since May, when it attempted to “mark up” legislation in committee.
What Does It Mean for Clinical Pharmacy?
Many ACCP members are aware that the College’s top legislative priority has been to secure coverage for clinical pharmacy services under Part B of the Medicare program. As the 111th Congress got under way, it became increasingly clear from our lobbying efforts that the old model of fee-for-service payments in Medicare was increasingly out of favor as a reimbursement method.
In addition, the proposed expansion of the public role in providing health care beyond the existing Medicare and Medicaid programs meant it was important to broaden and simplify our proposal to ensure the inclusion of pharmacists’ services in whatever new health delivery models were developed in this process.
Of all the legislation in circulation, the Senate HELP legislation would provide the most comprehensive coverage for pharmacists’ services:
- Section 212 of the HELP bill would provide grants to establish community-based multidisciplinary, interprofessional teams, including pharmacists (referred to as ‘‘health teams’’) to support primary care practices within the hospital service areas served by the eligible entities. This approach is popularly known as the “medical home model.”
- Section 213 of the HELP bill would establish grant programs to expand opportunities for pharmacists to deliver medication therapy management (MTM) services through local, community-based, multidisciplinary health teams to patients who suffer from chronic diseases such as heart disease, cancer, and diabetes.
These two sections were also included in the final House Energy and Commerce legislation after Rep. Butterfield (D-NC) introduced an amendment late in the final mark-up process that ensured their inclusion.
Fifteen national pharmacy organizations formally endorsed this language and applauded the recognition of the value of MTM services delivered by pharmacists and the inclusion of clinical pharmacists in the medical home model.
A formal press release was sent by the pharmacy community, expressing its support for these sections, and letters were sent to leaders on the HELP Committee, thanking them for their leadership on this issue.
Legislation passed by the House Ways and Means and Education and Labor Committees includes coverage for MTM services and discussion around the medical home model, but stops short of specifically referencing pharmacists.
Advocacy Outlook for Clinical Pharmacy
Assuming that some form of the health care overhaul proceeds as planned and the entire effort is not derailed by partisan or ideological stalemate, the outlook for clinical pharmacy can be described as cautiously optimistic.
The provisions endorsed by ACCP represent just a tiny fraction of the overall bill and, compared with many of the controversial aspects of this debate, would be considered by most casual observers logical and appropriate. The provisions do not carry a significant price tag – in fact, some indicators suggest they would be budget-neutral because the MTM grant programs could pay for themselves through savings.
In addition, ACCP has been active in working with a variety of coalitions and provider groups to gain support for the inclusion of pharmacists as part of an integrated, interdisciplinary team and to participate in efforts to manage health care through the concept known as the medical home model. Although we are a long way from declaring victory in this endeavor, it is clear that our advocacy efforts are gaining traction, and the feedback from other provider groups and stakeholders has been positive.
How You Can Get Involved – ACCP Advocacy Resources
The inclusion of coverage for clinical pharmacists’ services in the health reform legislation represents an important early step forward. Now, Congress needs to hear directly from the pharmacy community how important these provisions are in helping ensure a safer, more rational, and cost-effective approach to medication use.
All ACCP members are strongly encouraged not only to contact members of Congress themselves, but also to encourage friends and colleagues within the pharmacy community to take action.
As an introduction to grassroots advocacy, please visit ACCP’s “Legislative Action Center” (http://capwiz.com/accp/home/), an online tool that allows you to access information on your elected officials and contact them directly by e-mail.
By simply entering your zip code, you can send letters, by e-mail, to your federal elected officials. In addition, you can use the site to contact media outlets in your area or to communicate with federal agencies or the administration.
You can also use the tool to access the names of key congressional staffers in each office and committee, member committee assignments, biographical and background information on each elected official, fundraising data, PAC contributions, and much more.
Invite your legislators to tour your practice setting. Perhaps the single greatest challenge facing the pharmacy community in Washington is the enduring perception that pharmacists are drug dispensers who play no role in patient care.
The single most effective step that an ACCP member can take to help members of Congress understand the differences between traditional retail pharmacy and the patient care services provided by a clinical pharmacy is to invite members to tour a practice setting and see firsthand what clinical pharmacy is all about.
ACCP has prepared a guide to help you reach out to members of Congress and schedule a visit. We have even drafted a letter you can send directly from the Legislative Action Center, inviting your federal officials to tour your facility. Click here to visit the site and send a letter yourself.
Please make sure to secure the necessary approval from your organization before requesting that members of Congress tour your practice setting. Please work closely with ACCP staff in Washington to ensure that your practice tour is as effective as possible. We can help you prepare for the event and follow up on it for maximum impact.
For more information on grassroots advocacy or the health care reform process, please contact John McGlew at (202) 756-2227 or [email protected].
References
- Daily Telegraph article. UK cancer survival rate lowest in Europe. Available at http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html. Accessed September 10, 2009.
- UK NHS provider-based hospital waiting list statistics, quarter 2 2008/09. Available at http://www.performance.doh.gov.uk/waitingtimes/2008/q2/MMRPROVIN%20summary.xls. Accessed September 10, 2009.