As the members of the 116th U.S. Congress arrive in Washington, DC, the American College of Surgeons (ACS) Division of Advocacy and Health Policy (DAHP) is reexamining its legislative priorities and preparing for the transition to a new Democratic majority in the U.S. House of Representatives. The DAHP is responsible for advancing the College’s health policy agenda through Congress via lobbying activities, grassroots efforts, and political affairs. To help develop and advocate for health care policy that is in the best interests of patients and surgeons, the DAHP liaises with federal and government entities—including Congress, the Centers for Medicare & Medicaid Services (CMS), and other agencies that fall under the administration of the U.S. Department of Health and Human Services (HHS)—on a variety of issues of importance to the surgical profession.
The DAHP reported many legislative successes during the 115th Congress (see a full list online), and to ensure a similar track record in this Congress, the support of ACS Fellows for the College’s advocacy activities is essential. Using online tools and resources available via SurgeonsVoice, particularly increased engagement through legislative calls to action and other activities available to surgeon advocates, will be critical to ensuring that surgical health policy priorities are addressed on Capitol Hill.
Inside the 116th Congress
On a daily basis, both academic and practicing surgeons are affected by issues such as reducing administrative burdens and regulations, modifying and implementing Medicare physician payment reform, improving electronic health record (EHR) and health information technology (HIT) interoperability, and more. The ACS federal legislative team regularly monitors Congress’ agenda to determine the issues that have the potential to affect surgeons and surgical patients.
While ACS leadership determines overarching guidelines and policies aimed at serving the needs and concerns of Fellows, Congress—particularly the majority party—sets the legislative and regulatory agenda. For example, during the 115th Congress, a Republican-led House of Representatives advocated for many of the issues mentioned above, including reducing administrative burdens and regulations, modifying and implementing Medicare physician payment reform, improving EHR and HIT interoperability, addressing the opioid epidemic, and providing Children’s Health Insurance Program (CHIP) funding. Under a Democrat-controlled House, matters such as drug pricing, Medicare and Medicaid, comprehensive health care reform, scope of practice, and medical liability reform could be at the forefront.
The role of congressional committees in the legislative process
In addition to a Democratic House majority, a Republican-controlled Senate, and several new health professionals serving in the 116th Congress (the full list is available online), more appointments to U.S. House and Senate leadership positions, as well as several key committees with jurisdiction over health care-related issues, are expected.
Determining committee sizes, ratios, and assignments are among the first actions taken following a general election and the start of a new Congress. While the majority leadership decides the apportionment of committee seats, primarily to control voting outcomes, discussions between majority and minority party leaders often occur to ensure equitable distribution.
Most new legislators come to Congress with a wish list of committee assignments they believe could benefit constituents or interests in their district, state, or region. Selection and service depends on several factors, including party affiliation, seniority, eligibility (term limit, additional committee assignments, and so on), and geography.
Undoubtedly, membership changes within key health care committees could affect surgical advocacy. Consequently, the College’s federal legislative team will spend considerable time educating new members of Congress, their staffs, and these committees about the ACS’ health policy priorities.
House Committee on Energy and Commerce
The Committee on Energy and Commerce is one of the oldest standing committees in the House of Representatives and focuses on matters pertaining to health care, as well as telecommunications, consumer protection, and energy policy. Rep. Frank Pallone (D-NJ), who has served on the committee since 1992, chairs the Energy and Commerce Committee. The College is most actively involved with the Energy and Commerce Health Subcommittee, which has jurisdiction over HHS, CMS, the National Institutes of Health (NIH), and the Food and Drug Administration (FDA). A number of the College’s legislative priorities pass through the Energy and Commerce Committee, including topics related to physician payment, cancer and trauma care, HIT, opioids, drug pricing, and medical liability reform.
House Committee on Ways and Means
The Committee on Ways and Means is the oldest committee of the U.S. Congress and is the chief tax-writing committee in the House. Chaired by Rep. Rich Neal (D-MA), the committee oversees revenue-related aspects of Social Security, Medicare, and social services programs. Because the U.S. Constitution requires that all revenue-raising provisions originate in the House, the Committee on Ways and Means is considered influential. This committee has jurisdiction over several of the College’s legislative priorities, including Medicare physician payment, the “Stark law,” rural health care, and regulatory issues.
Senate Committee on Finance
Considered one of the most influential congressional committees, the U.S. Senate Committee on Finance is responsible for taxation and other revenue measures in addition to overseeing issues pertaining to health programs under the Social Security Act, including Medicare, Medicaid, CHIP, Temporary Assistance to Needy Families, and other health and human services programs. Following Sen. Orrin Hatch’s (R-UT) retirement, Sen. Chuck Grassley (R-IA) now chairs the committee, which comprises six subcommittees. The College is actively involved with both the full committee and the Subcommittee on Health Care. Nearly every legislative priority that would require a legislative fix or offset to Medicare or physician payment reform falls under this committee’s oversight.
Senate Committee on Health, Education, Labor, and Pensions
The Senate Committee on Health, Education, Labor, and Pensions (HELP), chaired by Sen. Lamar Alexander (R-TN), has jurisdiction over nearly all agencies, institutes, and programs within HHS, including the FDA, the Centers for Disease Control and Prevention (CDC), NIH, the Administration on Aging, the Substance Abuse and Mental Health Services Administration, and the Agency for Healthcare Research and Quality. Hence, this committee has the ability to affect initiatives critical to the College such as opioids, HIT and EHR interoperability, and others. With 23 members, the HELP committee has three subcommittees, including a Subcommittee on Health. The College predominately engages with the full committee as this is where most health care-specific issues are deliberated. Given the scope of this committee’s work, ACS works closely with its members and staff to help identify potential new policy priorities.
The first 100 days
Among the extensive list of issues affecting the surgical profession and patients every day, Congress will determine what concerns rise to its level of consideration. As the ACS Health Policy and Advocacy Group determines the DAHP advocacy agenda and priorities for the 116th Congress, the federal legislative team will continue to monitor re-introduction of ACS-supported legislation; new policies and regulations on which the ACS might have an opportunity to weigh in; and other big picture, health care-related initiatives.
The effects of a divided Congress and impending presidential election will certainly complicate the policymaking process. Nonetheless, the ACS DAHP will continue to advocate for policies that have the potential to affect access to and delivery of quality surgical care.
For more information about the College’s advocacy and political activities, and ways Fellows can become more involved in these efforts, visit the ACS website.