January 09, 2019

ACR's Moran Rates Prospects for 116th Congress

Cynthia Moran, ACR Executive Vice President of 
Government Relations and Health Policy

After eight years of Republican control, the House of Representatives is adjusting to a new session with a 36-seat Democratic majority and the second ascendancy of Rep. Nancy Pelosi (D-Calif.) as House Speaker.

These are still early days for the 116th Congress, but it is already clear that this legislative body is far more politically progressive than the lawmakers who sat in the chamber just nine days ago. As the new Congress completed its first week, Advocacy in Action eNews asked Cynthia Moran, the American College of Radiology’s (ACR’s) executive vice-president of government relations, economics and health policy, to access how the health care policy objectives of the new House and Senate compares with the priorities of the ACR’s own legislative agenda.

We have reported that the ACR has excellent relationships with all members of the House and Senate leadership teams in both political parties. Will the ACR’s amiable position continue with Democrats now in control of the House of Representatives?

There isn’t any question. We have spent years developing these relationships. The wheels of power change constantly. You would be practicing legislative malpractice if you didn’t work at developing relationships on both sides of the aisle.

How will the ACR’s ongoing lobbying efforts be affected when the Democrats exert their control over the key House committees that most often address health care policy issues?

At least in the beginning, we are going to see a fairly cohesive Democrat caucus. There is the potential for a split between progressives and moderates, but Speaker Nancy Pelosi controls the caucus, and it appears as if there will be a real effort for party unity, with most Democrats using the same talking points and maintaining a consensus in line with the leadership’s agenda.

House Speaker Nancy Pelosi played a pivotal role in the passage of the Affordable Care Act (ACA). What actions can we expect from her in 2019 to protect the law from threats from the courts and the Trump Administration?

From the get-go, her priority will be to shore up the Affordable Care Act. This week, we expect the House to take up a resolution to defend the health care law against the legal challenge (to the constitutionality of the ACA) in Texas. I expect a resolution will pass the House, affirming its ability to weigh in on that court case.

The speaker has also talked about shoring Medicaid expansion in states that did not expand access to the program. I think you’ll see legislative efforts to make Medicaid expansion more attractive. This will be interesting to watch because there are indications that President Trump may support some of those efforts to expand Medicaid in some states. Republicans have traditionally added more requirements, such as work requirements, to qualify for Medicaid. They will continue to do that, but I think the goal is to expand the ability of people to gain access to Medicaid when they need it, while trying to make it less of a permanent entitlement program, which is the Republican desire for the program.

Can we expect protections against further erosions of ACA mandates for preventive services coverage, such as screening mammography and lung cancer screening?

If you take down all the titles of the Affordable Care Act, access to free preventive services could be impacted, and we support continued access to these services. Right now, people aren’t really talking about the preventive services provision. They are talking about potential impact on preexisting illness coverage, which has become a huge political issue. This is why House Democrats are going to weigh in on the court case in Texas, since they perceive a political benefit of pursuing this vote by getting Republicans on the record regarding their opinions on the insurance reforms in the ACA.

Is implementation of PAMA-AUC in January 2020 a foregone conclusion?

It is as far as CMS (the Centers for Medicare & Medicaid Services) is concerned. CMS acknowledges that they can’t back away from the legislative mandate, but we know that we have detractors to the program from some in organized medicine who still do not understand how an appropriate use criteria (AUC) program differs significantly and is a vast improvement from any other utilization management system. We also have detractors who feel that any physician that fully complies with the Quality Payment Program (QPP) should also be deemed in compliance with the PAMA-AUC mandates. The ACR disagrees with this policy approach, which would substantively reduce the potential effectiveness of the PAMA AUC program and would have to be approved by the new Congress. When you look at the entire legislative environment and all of the policies the House Democrats want to enact, I don’t know if reopening up PAMA will be a priority in the new Congress. We will fight hard to prevent any significant change to the AUC program until its full implementation.

Is there now a greater probability that the Congress will mandate Medicare coverage of CT colonography (CTC) with Democrats in control of the House?

It’s still a hard thing to sell to Congress because of how the government addresses costs. If Medicare decides to cover CT colonography, the cost of screening would be financed within the Medicare Physician Fee Schedule. If Congress mandates CTC, those costs would show on the legislative ledger. CTC colon cancer screenings will involve substantial costs, but the clinical benefits of the screening exam are undeniable, so we will continue to push for its coverage. The fact that U.S. Preventive Services Task Force has begun its processes for the annual five-year review of the screening procedure also will have unknown consequences on our legislative efforts pertaining to CTC.

Because of the progressives’ greater emphasis on consumer protections, I would assume that there will be a greater likelihood that the House will consider surprise medical billing legislation?

That is very likely, and it’s going to a very divisive battle. Last Congress, the majority of the legislative action was in the Senate. This Congress, we expect both chambers to take this issue up. The ACR, as well as our friends in the House of Medicine, are working hard to make sure any federal solution is palatable to radiologists and physicians, in general.

What must the ACR protect against during that debate?

Our efforts are to ensure that people understand the real problems, which are inadequate networks and the insurance companies’ ability to limit those networks. Carriers shouldn’t be allowed to offer health coverage plans that do not have an adequate number of hospital-based physicians, such as radiologists. Selling such policies is misleading and damaging to patient clinical outcomes. We would love to see insurers and, even to a lesser degree, hospitals assuming responsibility for ensuring that their patients are aware of who their providers are and what networks those providers are in. A lot of responsibility should fall in the lap of insurers. The debate is just beginning. We’ll see how it goes.

What else can radiologists expect from Congress in this new term?

The Administration has clearly put drug prices on its radar screen. We expect the president to aggressively go after the pharmaceutical industry. If the Administration decides to also pursue site neutrality or other proposals that would zero in on physician payment, you’ll see people running to Capitol Hill for protection. Whenever Congress debates physician payment issues, it quickly devolves to specialty medicine versus primary care and diagnostic imaging services become very vulnerable in that kind of debate.

It is all going to be very issue-specific. Sometimes, we will want Congress to help us, and sometimes, we’ll be fighting one house or both houses of Congress. Sometimes, we’ll support the Administration. And sometimes, we’ll want to have Congress help us fight the Administration. This may be a year of a lot of fire drills (leading to the failure to pass legislation) and not a lot of public law signing ceremonies. But the ACR must respond to every fire drill. We have to treat each one as a potential threat that is going to imperil our agenda. It is going to be a very, very busy year.