The Academy’s fight for family medicine is nothing if not a long game. Sometimes, though, the playbook calls for the old ghost blitz.
That was the maneuver last week when the AAFP’s president, Board chair and Board members conducted a high-powered, minutely scheduled day of lobbying pandemic-style — virtually.
How’d it go?
“Great day, great day,” Academy President Ada Stewart, M.D., of Columbia, S.C., said on the video call that participants shared afterward to debrief.
It was a full day, certainly. Stewart’s agenda had included sit-downs with staff from her state’s senators, Lindsey Graham and Tim Scott, and Rep. Joe Wilson, also R-S.C.; additionally, she joined AAFP colleagues for meetings with staff for House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Chuck Schumer, D-N.Y.
Board Chair Gary LeRoy, M.D., of Dayton, Ohio, took a similarly upbeat tone in recounting his day. “I had a really good time,” he said of his appointment with staff members for Sen. Sherrod Brown, D-Ohio. “We made a connection. Before the day was over, a staffer called me to let me know about a special call set up Friday on vaccinations.”
Stewart’s and LeRoy’s experiences were characteristic of our broader endeavor because they stretched across both political parties. Our board members live in red states and blue states, and their meetings balanced time down the middle of the aisle.
One common result observed during the debrief: Republicans and Democrats alike expressed interest in joining the 51 (as of January 2021) of their colleagues who are members of the Congressional Primary Care Caucus, a bipartisan coalition we strongly support. After all, if ever there were a moment when every politician needed to be alert to the health of every American — and responsive to the workforce most prepared to improve that health, even as it is increasingly squeezed — that moment is now.
With the primary care workforce in mind, the urgent requests we took to the Hill focused on a handful of key issues now in play as the American Rescue Plan inches forward. (Several provisions for which we have advocated steadily — including COBRA subsidies, enhanced premium tax credits, postpartum Medicaid expansion and Teaching Health Center Graduate Medical Education program funding — are included in the House-passed bill.) That sharp agenda also reflects a varied array of concerns shared by the greater AAFP membership.
In particular, we again emphasized that Congress must increase Medicaid payment rates to at least Medicare level, righting an imbalance that threatens numerous primary care practices and worsens health outcomes. (Stewart said that Sen. Scott of her state “says he’s written to HHS and CMS regarding parity.”)
To that end, we called on every representative to co-sponsor the bipartisan Kids Access to Primary Care Act and for every senator to support the Ensuring Access to Primary Care for Women and Children Act — existing legislation that would increase Medicaid enrollees’ access to primary care and ensure that primary care clinicians have enough resources to meet what we know will often be complex needs.
Another priority for us remains solidifying deductible waivers for critical primary care services delivered via high-deductible health plans. We know that high out-of-pocket costs are causing patients to delay essential care — a reality that’s especially problematic during a pandemic. Legislators, however, don’t necessarily accept this on faith.
Board member Margot Savoy, M.D., M.P.H., of Philadelphia, saw this firsthand when she met with a staff member for Sen. Pat Toomey, R-Pa.
“His staffer focused questions on, for instance, How do you know you are saving money? and Why don’t folks just pick a different insurance plan?” she told me.
In fact, we’ve known for a while now that enrollees in HDHPs are less likely than people without deductibles to be screened for breast cancer or hypertension and also have lower rates of flu vaccination — the kind of preventive care that the Congressional Budget Office analyzed last year for its effects on health outcomes and budgets. As that study puts it: “Even if a preventive medical service increases health care costs, the spending may still be worthwhile.”
“I think what I might try next time we talk is having specific details about the cost savings and pairing that with stories of folks who have HDHPs not because they wanted to, necessarily, but because it was all they could afford or all their employer offered,” Savoy said.
“We are consistent about bringing data, science, evidence and facts” to lobbying sessions, she added. In another of her meetings last week, with Sen. Bob Casey, D-Pa., that preparation was acknowledged. Staff in that office, she said, “value our ability to be reliable partners with them — they see us as science experts as they make policy decisions.”
“Overall I think the day went well,” Savoy told me. “It was difficult to get the staffers on the video, so it was done mostly by phone — talking to a black box. That said, we were able to fit in our points because they could take the call from where they were, and they were engaged — asking us questions and sharing information bidirectionally.”
Now I’m going to lobby those of you reading this who want to amplify your own constituent voices at this pivotal moment (and as the 2021 Family Medicine Advocacy Summit approaches).
First, please add your voice to our Speakout campaign calling on Congress to invest in primary care in the ways described here.
And if you can carve a little time out of your afternoon tomorrow, I urge you to attend our Center for State Policy’s “Advocacy in a Virtual World” webinar at 1 p.m. CT Wed., March 3.
We’ll talk about virtual event platforms and — with Erik Kanter, a government affairs and communications associate with Hoven Consulting, and a member from the Maryland AFP (which last month held a virtual advocacy meeting) — discuss how to adapt your tactics when in-person meetings aren’t an option. The webinar is open to AAFP members and chapter staff, and there will be an opportunity to ask questions during the event; register here. Expect to hear about virtual platforms and learn effective tips about lobbying through Zoom or Webex. Follow-up sessions this spring will focus on federal advocacy and how to polish your storytelling.
Savoy, a seasoned AAFP voice who’s now an experienced virtual advocate, has some good advice.
“Still prepare as if you were in person,” she told me. “They are still going to be asking probing and sometimes challenging questions, so be ready and prepared. Plan ahead who is running the meeting so you don’t step over one another on the video or phone.
“And have someone with access to Google. We got asked a few quick questions, such as the actual Senate bill number or which senator sponsored the bill, and while one of us kept chatting, the other searched and provided the information before we got off the phone.”
Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.