October 22, 2020, 4:01 pm News Staff -- It was the Republican pol who first mentioned George Floyd, and it was the Democrat who sounded relieved that his party’s presidential contest frontrunner could be called “an institutionalist.” That was as surprising as things got during “Navigating the Health Care Landscape,” the sometimes downbeat but reassuringly uncontentious main-stage political discussion at the virtual Family Medicine Experience on Oct. 15. Instead, the two partisan strategists and longtime acquaintances offering Academy members their insider perspectives concurred early on the likely outcome of the Nov. 3 election, then sounded mostly harmonious notes about the health policy challenges ahead and how they might be addressed.
GOP lobbyist Dean Rosen, a partner with Mehlman Castagnetti Rosen & Thomas, and his opposite party number Chris Jennings, founder and president of the health care consultancy Jennings Policy Strategies Inc., generally agreed about the presidential election (winner: former Vice President Joe Biden), health care inequities (they’re bad) and the battle over the Patient Protection and Affordable Care Act (it’ll probably remain the law of the land). Questioned by moderator Jennifer Haberkorn, a Los Angeles Times staff writer who covers Congress, the two identified weaknesses in their own respective political houses rather than pointing fingers at each other. And both tailored their analyses to suit the audience of family physicians, emphasizing how much is at stake for primary care next month and over the next four years.
“Health care is an important issue in every presidential election — never more so than this one, dating back to the primaries,” Jennings said. “On the heels of the 2018 midterms, which was really a referendum on health care, candidates discovered that Americans across all political affiliations were angry at cost and complexity. Since then, a once-in-a-century pandemic has exposed all the shortcomings of our system, including health care inequities and the fragility of employer-based insurance.
“Now we may be facing one of the most challenging government transitions in our history. And, regardless of outcome, health care will remain at the forefront of the political conversation — doubly so if Republicans remain in charge — with testing, approval, distribution, administration and monitoring of COVID-19 vaccines and therapeutics at the heart of it.”
Rosen also called out historical parallels, noting that the 1918 flu pandemic was accompanied by mass protests and recession in this country but not by a national election, whereas 1968 brought another flu pandemic, political and social turmoil triggered by assassinations and a presidential election — but no recession.
“Now, we have all of those factors,” he said. “This is an enormously disruptive time — the most disruptive we’ve had.”
With Supreme Court nominee Amy Coney Barrett’s Senate hearings underway and the court set to hear arguments on the ACA next month (the AAFP weighed in early on), Haberkorn asked the panelists about the future of that law.
“The Democrats’ strategy has been to keep Republicans on the defensive about health care,” Rosen said. “So while we may disagree about mandates and tax penalties, Americans don’t like insurance companies. They don’t like having to pay copays for COVID treatment or being excluded from coverage because of genetic conditions. These are very powerful issues, and Republicans are having a hard time defending because you can’t beat something with nothing.
“I give Biden credit for not moving to the Medicare-for-all extreme. But the question of whether we can shore up the private market, get Republicans to a place where they acknowledge this as the law of the land and avoid full government control is a fundamental challenge of our time.”
Jennings said that, if Biden wins and his party gains control of the Senate, shoring up the ACA would be just one among “multiple competing priorities — No. 1 of which is COVID-19.”
He went on: “I think Biden would have to, thanks to the Republicans, focus on health care no matter what. The Supreme Court will have heard the case against the ACA but not ruled, so there’ll be need for congressional intervention. Is that a simple fix or something broader? You have to presume that Biden would be on the hook for proposing and promoting whatever that looks like.”
“If we stay divided, it’s going to be a slog,” Rosen said. “You’re going to see states rush in and put reforms in place, but that would reach only some of the market. You have forces in both parties that will work against a rational response reflecting what most Americans want to see protected, but the American people will not stand for bickering over whether they should be protected from a preexisting condition exclusion.
“I’m not sure either party has guts to take on health care costs, but I think a year from now the fundamental tenets of the ACA will still be in place, leaving aside whether someone wants to repeal it and others want Medicare for all.”
“I feel the Democrats will be in the majority and then amend and protect the ACA,” Jennings said. “And we can do better with alternative payment models for primary care and prevention and chronic care.
“But we need to do major work in terms of workforce recruitment and retention and then work on equity. We have mistrust of health care from minorities that we have to address, as well as issues in tracking inequities. Major commitment is required. I think a Biden administration would make that commitment, but it’ll take years to do it right.”
Rosen, too, named equity among what he called the “indelible health care issues” feeding into this moment: “an extremely complex health care system that’s the most expensive in the world, with worse outcomes than many other countries,” treating patients who are “older, sicker and fatter” than ever without addressing health inequities or renewing public health funding.
“George Floyd and Breonna Taylor and COVID-19 have exposed underlying disparities in health equity by race, income and geography,” he said. “And, regardless of administration, we’ve allowed our public health money to dwindle and seen our state and county officials shrinking in number while crises are coming more rapidly.
“I don’t think either party political party is well equipped to speak to or deal with these issues.”
But primary care physicians and the Academy, Jennings pointed out, are well equipped to advise and lobby policymakers and legislators. And an election that swings as the speakers — and most polls — project, he said, “will open up avenues to advocate for issues you care about: value-based alternative payment models, mental health integration, addressing social determinants of health and disparity issues, workforce modernization, and drug costs.”
AAFP Senior Vice President of Advocacy, Practice Advancement and Policy Stephanie Quinn drove home that message in a video postscript to the panel in which she outlined the Academy’s key advocacy priorities, including the following:
“We have been pursuing a special allocation of the provider relief funds for primary care to ensure that practices remain viable,” she said. “We have also called on Congress and the Small Business Administration to make sure that primary care practices are able to take advantage of the Payroll Protection Program and other relief for small businesses. In addition, we have called for the reinstatement of Medicare’s Accelerated and Advance Payment program for Part B providers with more favorable repayment terms.
“We are also working to strengthen the existing fee-for-service payment framework to ensure that primary care is appropriately valued, urging CMS to implement increases to the evaluation and management codes and to adopt a new add-on code for complex visits. There are efforts underway by some specialties to undermine these changes, and we are fighting to ensure that they are ultimately not successful.”
The Academy also has urged Congress to direct the Center for Medicare & Medicaid Innovation to expand existing alternative payment models such as Primary Care First, and accelerate movement toward more sustainable payment designs, she said.
“We are urging Congress to remove Medicare originating and geographic site restrictions so all beneficiaries can access telehealth, regardless of where they are located,” Quinn said.
The AAFP’s collaboration with the administration on the “Patients Over Paperwork” initiative “has resulted in favorable changes to Medicare (evaluation and management) documentation requirements and a delay of the Appropriate Use Criteria program,” Quinn noted.
“We have been seeking streamlined prior authorization processes and engaging in advocacy with private payers to stress the importance of alignment in reporting requirements and quality measures," she added.
“The pandemic has illustrated gaps in care that must be addressed,” Quinn said. “We are working to address this through improved and standardized data collection. We are also continuing our work to reduce maternal mortality, which continues at an alarming rate.”
Quinn ended by calling on members to vote and urging participation in the Academy’s political action committee, FamMedPAC. “You can also make your voice heard by sending messages to your members of Congress,” she said, indicating AAFP Speak Out campaigns now underway.