ACA, firearms among advocacy hot topics for ACP

The Affordable Care Act will be 10 years old next March.

Thursday's “Special Report on Hot Issues in Health Policy” began with an issue that has retained its heat for a surprisingly long time. “The Affordable Care Act (ACA), believe it or not, is going to be 10 years old next March,” said Robert B. Doherty, ACP's Senior Vice President for Governmental Affairs and Public Policy.

For a while, it didn't look like the law would make it to that birthday. “Everybody in this room remembers that night the first week of November 2016,” said Richard L. Trachtman, ACP's Director of Legislative Affairs. “I remember hearing the conventional wisdom at the time that that was it; the Affordable Care Act was history.”

But in part thanks to the advocacy work of ACP and its members, the law, with its pre-existing condition protections and Medicaid expansion (among other benefits), has stayed in place, the College's legislative experts said. It currently faces yet another challenge, now that a Texas court has ruled that elimination of the tax penalty for being uninsured has rendered the law unconstitutional.

“It really would be devastating if the Circuit Court were to agree with the Texas judge,” said Mr. Doherty. “It's a pretty shaky legal argument, and most attorneys, including ones who oppose the ACA, don't think the case is very strong.”

ACP will submit a brief in support of the ACA, and a decision is expected in the fall. Whatever the verdict, it will probably be appealed, Mr. Doherty noted.

Gun control is an even longer-standing health policy issue that has recently heated up. Mr. Doherty described how last year's update of ACP policy on firearms became a media sensation and one of the most-cited policy papers of all time.*

The paper, which called for background checks, closing of domestic violence loopholes, and prohibition of assault rifles, among other steps, led the National Rifle Association to tweet that “Someone should tell self-important anti-gun doctors to stay in their lane.”

“That wasn't well received by the medical profession,” said Mr. Doherty. “We saw an incredible organic response.”

The outpouring of physicians and other clinicians who voiced their support for gun control, using #thisisourlane as a Twitter hashtag, showed the impact doctors' advocacy can have, according to Mr. Trachtman. “This is just the latest example that physicians are respected,” he said. “You have that credibility, and you should use that credibility.”

The push for new gun laws has had some recent successes, at least on the state level. “More and more states are enacting legislation consistent with ACP's positions,” said Mr. Doherty.

ACP has also had successes in regulatory advocacy, reported Shari Erickson, MPH, ACP's Vice President of Governmental Affairs and Medical Practice. “This is an area where we will have a real opportunity to work with the administration,” she said. Ongoing efforts involve the push for interoperability of electronic health records, changes to the physician fee schedule, implementation of new payment models, and efforts to reduce paperwork.

While the College continues to work on these issues of importance to internists, public attention will be shifting to the presidential election. “I think health care is going to be huge election issue,” said Mr. Doherty. “I suspect whoever wins the Democratic nomination is going to be an advocate, if not for Medicare for all, for people to have the option to enroll in a public plan.”

President Trump can be expected to offer a competing concept. “He'll be proposing a radically different approach to health care, probably centered on block grants to states,” Mr. Doherty predicted.