They didn't have the votes.
The American Health Care Act (AHCA), the first attempt by the new administration and the 115th Congress to repeal and replace the Patient Protection and Affordable Care Act, was pulled from consideration March 24 when Republican House leaders were unable to secure the number of votes needed for passage.
Lalita Abhyankar, M.D., M.H.S.
One reason they didn't have the votes is because physicians have a voice, and a powerful one at that.
As physicians, legislation profoundly affects our ability to serve our patients -- a realization that has not been lost on members of the AAFP. In January and March, the Academy hosted Speak Outs -- letter writing campaigns that empowered family physicians to encourage their lawmakers to vote against the AHCA. Through those two efforts, family physicians contacted their representatives more than 6,700 times, advocating on behalf of patients with the clear message that no law enacted by Congress should make health care worse.
Our elected leaders have to continue to hear from family physicians. Only three members of Congress are physicians with backgrounds in primary care. That's three people out of 535 who might not need convincing that primary care is the best way to provide cost-effective health care to millions of Americans. Unfortunately, Congress is prone to influence from special interest groups such as pharmaceutical companies, hospital conglomerates and insurance companies that can persuade lawmakers to focus on their bottom lines, not the best interests of patients.
Primary care physicians, on the other hand, can choose to be the conscience of the medical community. At the AAFP's Family Medicine Advocacy Summit (formerly the Family Medicine Congressional Conference) last year, discussions of new policies for issues such as reimbursement always came in the context of patients and their needs. Family physicians emphasized the importance of creating sustainable and multidisciplinary practices to improve patient-centered outcomes. The stories we shared with legislators were substantively about our patients and less about us as physicians. Regardless of political affiliation, our conversations centered on how health care disparities reflect economic disparities, and how access to care is only one part of ensuring that our patients live healthy lives.
As family physicians, we are involved in every aspect of the health care continuum: initial presentation, medication management, discharge follow-up and referral. We see how social and political determinants of health can affect everything from birth to end-of-life care. We already advocate for our patients on a personal level, and increasingly, they depend on us to speak up on the local and national levels to make sure they receive the access and care they deserve.
As with our patients, the best way to influence policymakers is to build relationships with them. We meet with patients regularly, follow up results and check in when needed. With legislators, we must make frequent trips to their offices, call and write to their staff, and interact with them regularly at community events. If policymakers and support staff know who you are and know your experience as a physician, they will be more likely to seek your advice when legislation dealing with health care or related issues is up for discussion.
Don't be disappointed if your interaction is limited to congressional staffers. They may be young, but the elected official specifically chose them for the topics they cover. Make no mistake; they have the ear of your representative. Save your legislators' contact information in your phone so you can call and leave a message when an issue piques your interest. These calls typically last about two to five minutes, and they can make a dramatic impact in the mind of the legislator. Although social media and letters are great ways to contact your elected officials, in-person visits and phone calls are often more effective.
It's also vital to be informed so you can present the facts, add patient stories and have a clear "ask." The AAFP has easily accessible policies that can help in building fact sheets for your members of congress. For example, during the Family Medicine Advocacy Summit in April 2016, the AAFP provided participants with a one-page fact sheet on curbing prescription drug abuse. The document included brief pitches supporting increased funding for prescription drug monitoring programs (PDMPs), naloxone availability in first responder and nonmedical settings, and expanding the number of patients who could receive treatment for addiction in primary care settings. When we met with staffers, we shared our fact sheets and provided the human element. We told stories of patients who died because first responders did not have naloxone, and about how we have used our state PDMP to identify patients who abuse the medical system. The AAFP is also happy to create personalized fact sheets, so don't hesitate to reach out.
Two days after the conference, the artist and musician Prince died of a prescription opiate overdose, amplifying the dangers posed by the narcotic epidemic. That summer, Congress passed legislation(www.congress.gov) and HHS released a new rule(s3.amazonaws.com) that included every single one of our "asks."
This year, the Family Medicine Advocacy Summit will take place May 22-23 in Washington. The first day will offer education regarding family medicine's legislative priorities and training on how to lobby on Capitol Hill. On the second day, attendees will put those new skills to work by visiting congressional leaders and talking with them about the challenges we face.
The early-bird registration deadline is April 7.
For those who can't make it to Washington, family physicians across the country will be encouraged to participate in a Family Medicine Day of Action on May 23. This can include meeting with legislative staff in their home offices, emailing elected officials using AAFP Speak Out materials and advocating over the phone.
Family medicine has the respect and the numbers -- 124,900 Academy members -- to truly affect policy. We must show Congress what a united family physician front can do.
To learn more about how you can get involved, join the Family Physician Action Network. Here, members can gain access to congressional updates, members-only content, training, action alerts and more.
The process can be challenging. So why should family physicians continue to make the ask? Why should we diligently and persistently use our motivational interviewing skills with senators, representatives and congressional staff to win the training, resources, support and skills that we need to ensure the health of our patients?
The answer is simple: If we don't, who will?
Lalita Abhyankar, M.D., M.H.S., is a third-year resident at the Center for Family and Community Medicine at Columbia University Medical Center in New York.