Medicine & Health

Is there a doctor in the House? Yes, and they’re (mostly) all Republicans

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‘Enormous clout’

The GOP Doctors Caucus is highly influential within the Republican conference and its members work on a number of bipartisan health policy issues, lobbyists said. Modern Healthcare granted anonymity to some lobbyists who wanted to speak candidly without jeopardizing their relationships on Capitol Hill.

“On the Republican side, I very much have always perceived the doctors caucus to have enormous clout in health policy to the point that they’ve even written bills that have made their way into law,” said a lobbyist who has represented several different parts of the industry.

For example, when Republicans controlled the House in 2015, Rep. Michael Burgess (R-Texas), an OB/GYN, and the caucus played a key role in repealing the sustainable growth rate formula and establishing a new way to pay doctors through the Medicare and CHIP Reauthorization Act.

Sen. Bill Cassidy (R-La.) was among the leaders of the GOP’s efforts to repeal and replace the ACA in 2017. Although that gambit failed, President Donald Trump borrowed some of the gastroenterologist’s ideas and attempted to implement them through regulatory means.

Doctors were also heavily involved with the surprise billing ban Congress passed last year. The final product was viewed as being friendly to providers, with several doctors serving on committees that helped draft the legislation. Physicians in Congress are currently pushing back against the Centers for Medicare and Medicaid Services, which is responsible for implementing the law, for proposing regulations they argue are too friendly to insurers.

When Republican leaders need to test the waters on a healthcare policy, their first stop is the GOP Doctors Caucus, said another lobbyist. Their strength comes from their numbers, but it’s also one of the best-organized caucuses in the House, lobbyists say. Many congressional caucuses basically exist in name only, but the GOP Doctors Caucus actually holds meetings, meets with outsiders, issues policy statements and helps pass bills.

The lobbyist who has worked for multiple industries added that Democrats don’t usually care what a member’s professional background is. Republicans put much more stock in lawmakers’ medical experience, which makes them crucial ambassadors to their conference when it comes to health policy, the lobbyist said.

Several Republican doctors serve on committees that write healthcare laws. Burgess was the chair of the House Energy and Commerce health subcommittee for several years, including when the GOP tried to repeal the ACA in 2017, for example. Three of the Senate’s four Republican doctors—Cassidy, Marshall and Paul—sit on the Senate Health, Education, Labor and Pensions Committee. GOP Sen. John Barrasso (Wyo.), an orthopedic surgeon, and Cassidy are members of the Senate Finance Committee.

Bipartisanship

While Republicans are in the minority in both houses, there’s a very real chance they could win back the majority in 2022, putting the GOP Doctors Caucus back at the forefront of healthcare policymaking.

The last time Republicans had the majority, they tried to repeal the ACA, block-grant Medicaid and restrict access to abortion. The party successfully repealed the ACA’s individual mandate penalty, sparking a lawsuit from Republican state officials that threatened to wipe out the ACA but ultimately failed at the Supreme Court.

When the caucus is successful, it’s usually on less controversial matters, like physician reimbursement.

That drives a large part of the caucus’ work, Burgess said. “Most of us who are in office now came to this place from private practice, where we ran our own practices, and were responsible for our own hiring and firing decisions,” he said.

That’s why Republican doctor-lawmakers are the first ones some lobbyists turn to when they need help on payment and practice issues. “If you were a provider who was on the front lines dealing with (administrative) burden, those who had that kind of experience are most helpful,” a provider lobbyist said.

Rep. Brad Wenstrup (R-Ohio ), a podiatrist first elected in 2012, recalls being frustrated by the yearly anxiety about the looming fee cuts from the sustainable growth rate policy.

“Congress kept telling doctors across America: Keep seeing patients, paying staff and paying bills,” Wenstrup said. “Some revenue has to come in. We had to go and get credit. I don’t know that everyone in Washington understands that.”

There is some bipartisan support on some of these smaller healthcare issues, said Rep. Ami Bera (D-Calif.), an internal medicine doctor who is teaming up with Rep. Larry Bucshon (R-Ind.), a cardiothoracic surgeon, to push for Medicare pay increases.

“If you take out their attempts to repeal the ACA, set that aside, and take some of the social issues,” Bera said, “there are more places we can work together.” Payment reform, prior authorization and workforce issues are some examples, he said.

Another area of common ground Republican and Democratic doctors in Congress cited is frustration with increasingly burdensome insurance rules.

Wenstrup and Ruiz are working on legislation to limit “step therapy,” an insurer policy that requires patients try cheaper drugs first before moving on to more expensive ones.

“Dr. Ruiz and I can very easily relate to what this does sometimes to patient care,” Wenstrup said. “You have people deciding what someone should receive as their treatment when they’ve never even seen a patient before. That doesn’t seem appropriate.”

Those bills may not advance next year, but the looming midterms and a post-election “lame duck” session could mean Congress turns to bipartisan priorities.

Specialty vs. primary care

Almost all of the Republican doctors serving in Congress are specialists, unlike the majority of U.S. doctors, who practice primary care, family medicine or pediatrics. But these lawmakers do tend to represent the political views of the majority of their fellow specialty practitioners: Surgeons, anesthesiologists, urologists and other specialists are more likely to be registered Republicans, according to a New York Times analysis from 2016.


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