Federal opioid package receives bipartisan support in the U.S. House On June 22, the U.S. House of Representatives passed HR 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. It includes more than 55 opioid-related bills intended to help combat the nation’s opioid crisis by advancing treatment and recovery initiatives, improving prevention, protecting our communities and bolstering our efforts to fight deadly illicit synthetic drugs. HR 6 also includes several Medicaid, Medicare and public health reforms to help combat the opioid crisis. The California Medical Association (CMA) aggressively advocated for more funding for prevention, treatment and alternative therapies and worked alongside the American Medical Association (AMA) to avoid legislation that interferes with the practice of medicine, such as mandating dosage and duration limits. CMA also secured an amendment (HR 58010) that prevents federal preemption of state laws that mandate physicians consult state prescription drug monitoring programs prior to prescribing. Unfortunately, HR 6 does include a mandate to e-prescribe controlled substances, despite opposition from CMA and AMA. Less than 25 percent of physicians currently e-prescribe controlled substances because of the antiquated DEA system. CMA and AMA will continue to urge Congress to require the DEA to update its program and reduce the costly burdens of e-prescribing controlled substances before mandating that physicians use it. The House also passed HR 6082, the Overdose Prevention and Patient Safety Act, expanding the circumstances under which medical records relating to substance use disorders can be securely disclosed to health care providers. The issue of opioid-related misuse, abuse and overdose remains a major policy issue at the federal, state and regional levels. CMA will continue to advocate to increase access and availability of medication-assisted treatment, opioid use disorder treatment programs, and non-opioid therapies, including mental health services and fight proposals that interfere with the practice of medicine and create barriers to care. Demonstrated Opioid Success in California and Across the Nation Like the nation as a whole, California is faced with a serious health care dilemma: how to prescribe controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. California has been leading the way in efforts to reduce prescription drug abuse and drug diversion. From 2013-2017, there has been a 22 percent decline in opioid prescriptions, which shows that physicians and other health professionals are increasingly judicious when prescribing opioids. California’s rate declined by more than 24 percent, with an 8.6 percent drop 2016 to 2017. From 2013-2016, California had the second lowest per capita rate of filled opioid prescriptions, and that rate dropped even more in 2017 – California now has the lowest per capita opioid prescribing rate in the country. California has one of the lower overdose death rates in the country. Unlike other states, California has seen its prescription opioid overdose rate decrease over the last two years. Safe Prescribing Resources CMA supports a well-balanced approach to opioid prescribing and treatment that considers the unique needs of individual patients. CMA’s safe prescribing resource page includes the most current information and resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose. There you will find: Resources on prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose CMA’s white papers on prescribing opioids Links to relevant documents in CMA’s health law library Continuing medical education courses and webinars Current information on the state's prescription drug monitoring database July 11, 2018 General Prescription Drugs, Drug Prescribing, Federal Legislative Advocacy 0 0 Comment Read More »
CMA physicians travel to D.C. to advocate on critical health care issues A California Medical Association (CMA) contingent of two dozen physician and medical student leaders recently traveled to Washington, D.C., to participate in the American Medical Association’s (AMA) National Advocacy Week. They met with 24 members of the California Congressional Delegation and top leadership of the Centers for Medicare and Medicaid Services (CMS) to advocate for many health care issues critically important to California physicians. While in Washington, California physicians focused on promoting the bipartisan Affordable Care Act (ACA) market stabilization bill that would reinstate the cost-sharing reduction payments and provide reinsurance funding, which together would reduce premiums by an estimated 20 percent. They also advocated for an immediate and permanent solution for the Deferred Action for Childhood Arrivals “Dreamers,” many of whom are medical students. They also insisted that the federal government needs to hold electronic health record (EHR) vendors accountable for interoperability. CMA physicians aggressively pushed Congress and CMS to provide more Medicare and Medicaid regulatory relief and expressed our significant frustrations with the 0.25 percent Medicare payment cut slated for 2019. Although the cuts initially proposed were much worse, the 0.25 percent cut will reduce by half the 0.5 percent payment update guaranteed to doctors in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMA warned Congress that physicians could not meet the difficult MACRA quality and EHR reporting requirements without adequate resources. CMA is urging Congress to restore the 2016 and forthcoming 2019 Medicare payment cuts, and to fund payment increases going forward. Much of the trip was dedicated to educating Congress and CMS about opioids. Congressional leaders are working on a comprehensive package to address the opioid crisis through prevention, treatment and law enforcement efforts. CMA physicians also met with the CMS Medicare Part D team to express serious concerns with the proposed regulations limiting initial opioid prescriptions to three days for acute pain. CMA thanks these physicians and medical students for taking the time away from their busy practices to travel to Washington, D.C., to meet with Members of Congress and CMS on some very important issues. April 5, 2018 CMA, General AMA, American Medical Association, Federal Legislative Advocacy 0 0 Comment Read More »
$1.3 trillion federal appropriations bill loaded with new health care spending Last Friday, President Trump signed a massive $1.3 trillion federal spending bill—the Omnibus Consolidated Appropriations Act of 2018. It is loaded with new spending for health care programs that were supported by the California Medical Association (CMA). Unfortunately, it did not include two bills that CMA was strongly promoting – the Affordable Care Act (ACA) market stabilization bill and a permanent solution for the nearly 700,000 Deferred Action for Childhood Arrivals program recipients. A brief summary of the federal spending bill is below. Bipartisan ACA Market Stabilization: CMA, the American Medical Association (AMA) and other physician groups strongly advocated to include the bipartisan ACA market stabilization bill in the omnibus spending package. Unfortunately, lawmakers could not reach a compromise. It would have funded for two-years the cost-sharing assistance that helps low-income families afford copayments and deductibles that President Trump eliminated in 2017. It would have also provided state waiver flexibility and reinsurance funding to cover high-cost, catastrophic cases. The Congressional Budget Office estimated that the bill would have reduced premiums by 20 percent in 2020. A compromise could not be reached because the Freedom Caucus insisted on placing abortion restrictions on the ACA plans in exchange for the two-year ACA stabilization bill. Opioids: The bill includes nearly $4 billion in new funding for prevention, treatment and law enforcement to address the opioid crisis. With the $6 billion in the Budget Act enacted by Congress in February, new 2018-2019 opioid funding totals $10 billion. The breakdown is as follows: $500 million for National Institutes of Health research on opioid addiction, development of opioid alternatives, pain management and addiction treatment. $27 million for Mental and Behavioral Health Education Training to recruit and train professionals in psychiatry, psychology, social work, marriage and family therapy, substance abuse prevention and treatment, and other areas. $105 million for the National Health Service Corps to expand access to opioid and substance use disorder treatment in rural and underserved areas. $100 million for a new Rural Communities Opioids Response Program to support prevention and treatment of substance use disorder in 220 counties and other rural communities identified by the Centers for Disease Control and Prevention (CDC) as being at high risk. $350 million (for a total of $475 million) to support CDC’s Opioid Prescription Drug Overdose Prevention activities. $10 million must be used to conduct a nationwide opioid education campaign to increase understanding of the epidemic and to increase prevention activities. Also requires CDC to promote the use of prescription drug monitoring programs (PDMP) and expand efforts to enhance the utility of state PDMPs to make them more interconnected, in real-time, and usable for public health surveillance and clinical decision making. CMA aggressively advocated for this provision to ensure that the federal government work with electronic health record (EHR) vendors to link EHRs to state PDMPs. $1 billion in new funding for State Opioid Response Grants $94 million for law enforcement and grants to combat opioid, heroin and other drug trafficking. $94 million to strengthen Food and Drug Administration (FDA) presence at international mail facilities and to fund equipment and technology to increase FDA capacity to inspect more incoming packages to detect illicit fentanyl. Gun Violence: The bill included $2.3 billion in funding associated with the STOP School Violence Act of 2018 to cover mental health services, security training and school safety programs to prevent gun violence. It also fully funds the FBI National Instant Criminal Background Check System. While CDC research promoting gun control is still prohibited, the Omnibus spending bill included a general clarification that there are no restrictions on general research related to gun violence. However, there was no funding appropriated for such research. Finally, it increased funding for the National Violent Death Reporting System to all 50 states to assist researchers and lawmakers. CMA continues to support California Senator Dianne Feinstein’s legislation that would ban assault weapons and high-capacity magazines, as well as efforts to require more extensive background checks and waiting periods. Mental Health Programs: Provides more than $2.3 billion in new funding for various mental health programs. Drug-Related Provisions: Physicians will continue to receive enhanced payments for the first few years a drug/biological is on the market to assist in the costs of adopting new drugs and technology. Graduate Medical Education: The Children’s Hospitals graduate medical education program received a $15 million funding increase, for a total of $315 million. Congress also provided an additional $15 million for the Rural Residency Program to expand the number of rural residency training programs with a focus on developing programs that can be self-sustainable. Other Notable Health Care Spending Increases: The National Institutes of Health received significant increase in funding to support research into Alzheimer’s disease, the Brain Initiative, the universal flu vaccine and antibiotic-resistance efforts. The CDC also received additional funding for diabetes programs. April 5, 2018 General Affordable Care Act, Drug Abuse, Federal Budget, Federal Legislative Advocacy, Firearms, Graduate Medical Education, Guns, Mental Health, Opioids 0 0 Comment Read More »
Stopgap bill to fund federal government includes 6-year CHIP extension Today, the U.S. Senate voted to end the federal shutdown and keep the government running temporarily for three weeks until February 8. This stopgap bill will give budget negotiators time to develop a final agreement on 2018 fiscal year spending. The House of Representatives is expected to adopt the Senate’s three-week stopgap bill. The bill also includes a six-year extension of the Children’s Health Insurance Program (CHIP) – an important program that serves nearly 2 million children and pregnant women in California, and more than 9 million nationwide. The California Medical Association (CMA) has been advocating vigorously for an extension of the CHIP program, which expired in October. Although the successful 20-year-old CHIP program has historically had bipartisan support, Congress had been unable until now to come to an agreement to extend the program. Over the past 20 years, CHIP has helped reduce the nation’s uninsured rate for children to a record low of 5 percent. It provides access to comprehensive coverage, mental health services and essential preventive services, such as immunizations and developmental screenings, to prevent more serious illnesses and disease. So far, CMA and the American Medical Association have also successfully fought-off the Medicare physician payment cut that was being contemplated as a funding source for extending some expiring Medicare programs. In return for Democratic votes on the stopgap funding bill, Senate Republican Leader McConnell has agreed to hold a Senate vote with open amendments on immigration issues, including the Deferred Action for Childhood Arrivals (DACA) program that expires in March. January 30, 2018 General Federal Legislation, Federal Legislative Advocacy, Maternal and Child Health, State Children's Health Insurance Program 0 0 Comment Read More »
CMA opposes proposed Medicare physician payment cuts The U.S. House of Representatives’ Ways and Means Committee is working to extend the “rural” work Geographic Practice Cost Index (GPCI) payment adjustment, which is set to expire December 31, 2017. In order to pay for the extension, the committee has proposed an overall cut to Medicare physician payments by identifying and lowering payments for “misvalued” services. In 2014, Congress included a physician-opposed provision in the Protecting Access to Medicare Act (PAMA), designed to hold down Medicare spending by requiring the Centers for Medicare and Medicaid Services (CMS) to identify “misvalued” codes. If CMS is unable to meet the savings target in the PAMA legislation, the remaining amount was to be obtained by an across-the-board payment cut to all services. The Ways and Means Committee is now proposing a fourth year of Medicare physician payment cuts to fund the rural work GPCI floor, despite the commitments made under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that physicians would be provided automatic, stable payment updates of 0.5 percent per year from 2015-2019. The California Medical Association (CMA) is urging the California Congressional Delegation to oppose the proposed cuts, which will disproportionately harm California physicians. The rural GPCI floor does not help California’s rural areas, while California physicians treat the bulk of Medicare patients in this country. The misvalued code legislation has eroded the modest MACRA payment increases at the same time that physicians were required to make significant investments in their practices to meet MACRA reporting requirements. Physicians are also facing a payment freeze from 2019-2024. If this new proposal takes effect, total physician payment updates for the entire 10-year period of 2015-2024 will be approximately 1 percent. From 2005-2015, physicians’ fees were essentially frozen under the Medicare Sustainable Growth Rate formula, while the costs to operate a medical practice rose more than 20 percent. These Congressional actions will represent more than two decades of nearly frozen payment rates, while all other Medicare provider groups have received updates. Physicians cannot remain in practice and maintain patients’ access to care under these flawed policies. This proposal harms all California physicians, particularly those in the Central Valley, where there are already significant physician shortages and margins to operate a practice are slim because the main payers are the low-paying Medicare and Medicaid programs. CMA is urging Congress to find other funding sources to fund the rural payment floor. December 28, 2017 Medicare Federal Legislative Advocacy, Geographic Practice Cost Index, GPCI, Medicare 0 0 Comment Read More »
CMA, AMA and organized medicine were united in opposing Graham-Cassidy Last week, the latest effort to repeal the Affordable Care Act (ACA) collapsed, after three Republican Senators announced their opposition—Susan Collins (R-ME), Rand Paul (R-KY) and John McCain R-AZ). Further action is unlikely this year, as Senate Republican Leader Mitch McConnell (R-KY) said the Senate would now turn its focus to overhauling the tax code. However, several Republicans vowed to continue to work into next year to repeal the ACA. The California Medical Association (CMA), the American Medical Association (AMA) and all of organized medicine were united in opposing this harmful bill, which would have repealed the ACA’s insurance mandate, underfunded health insurance subsidies and made drastic cuts to the Medicaid program. The Graham-Cassidy block grant proposal would have been disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. Even states that initially came out ahead under the block grant framework would have experienced devastating funding cuts over time from the bill’s Medicaid funding caps on children, the elderly and the disabled. Millions of Californians would have lost their coverage, and many others would have been seriously underinsured. Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs onto states, counties, health care providers and taxpayers. These patients also put off treatment, ending up with more serious conditions that could have been prevented. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill would also have allowed states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy. “Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said CMA President Ruth Haskins, M.D. In the meantime, bipartisan negotiations have resumed in the Senate between Health Committee Chairman Alexander (R-TN) and lead Democrat Patty Murray (D-WA) to adopt reforms to stabilize the individual market, such as funding cost-sharing subsidies and reinsurance. CMA and AMA support this effort. It has been a long and difficult year for physicians who want to make constructive improvements to the health care system. While the ACA has its flaws, none of the House and Senate proposals thus far have met CMA’s principles for health care reform. CMA and the physicians of California will keep fighting for reforms that increase patient access to health care and maintain coverage for the millions of Californians insured through Medi-Cal and Covered California. October 13, 2017 CMA, General, Managed Care, Medi-Cal ACA, Affordable Care Act, Affordable Care Act (ACA) Repeal, Covered California, Federal Legislation, Federal Legislative Advocacy, Medicaid, Medi-Cal 0 0 Comment Read More »
California's physicians oppose Graham-Cassidy repeal bill The U.S. Senate is currently considering the Graham-Cassidy block grant bill, which would repeal the Affordable Care Act’s (ACA) insurance mandate, underfund health insurance subsidies and make drastic cuts to the Medicaid program. Under the bill, traditional Medicaid funding would be capped. Medicaid expansion and ACA subsidies for low- and middle-income families would be subject to an underfunded block grant and phased out in 2027. This bill would be disproportionately harmful to states like California, which embraced Medicaid expansion and increased coverage under the ACA. In response, the California Medical Association (CMA), representing over 43,000 physicians in all specialties and modes of practice, called on the California Congressional Delegation to oppose this bill. Congress should work with health care professionals to craft legislation that increases patient access to health care and maintains coverage for the more than 15 million Californians insured through Medi-Cal and Covered California. “This bill would significantly reduce Medicaid funding, which provides health coverage for more than 13 million Californians,” said CMA President Ruth Haskins, M.D. “A vote for this legislation is a vote to deteriorate public health in California – especially in areas like the Central Valley, where approximately half of the population relies on Medicaid for health care.” Patients without coverage seek more expensive care in overcrowded emergency rooms, passing costs on to states, counties, health care providers and taxpayers. These problems would be exacerbated by the reduction of subsidies currently provided to poor and middle class families. The Graham-Cassidy bill also allows states to do away with pre-existing condition protections and other essential health benefits that keep Americans healthy. “Congress should engage with physicians and other medical experts on the front lines caring for patients to develop legislation that improves patient access to physicians, protects coverage for our most vulnerable populations and addresses affordability,” said Dr. Haskins. # # # The California Medical Association represents the state’s physicians with more than 43,000 members in all modes of practice and specialties. CMA is dedicated to the health of all patients in California. For more information, please visit CMAnet.org, and follow CMA on Facebook, Twitter, LinkedIn and Instagram. September 27, 2017 CMA, Medi-Cal Affordable Care Act, Affordable Care Act (ACA) Repeal, Federal Legislation, Federal Legislative Advocacy, Health Care Reform 0 0 Comment Read More »
CMA urges swift action to renew Children's Health Insurance Program The California Medical Association (CMA) is urging Congress to reauthorize the successful Children’s Health Insurance Program (CHIP), which is set to expire on September 30, 2017. Although the 20-year-old program has historically had bipartisan support, there has been some concern that the CHIP reauthorization could get caught up in the partisan bickering surrounding other priority issues, including attempts to repeal the Affordable Care Act (ACA). CMA has urged Congress to reauthorize the program for at least five years at current funding levels to give states the stability to engage in long-term planning and innovation. The U.S. Senate Finance Committee last week agreed to a five-year funding extension for CHIP. The proposal would also maintain the ACA’s 23 percent increase in the federal matching rate to states for 2018 and 2019. In California, the CHIP program currently serves 5.6 million children. Since its inception, it has successfully provided children of low-income, working families access to physicians so they have a chance to grow up healthy and thrive. It provides access to comprehensive coverage, mental health services and essential preventive services, such as immunizations and developmental screenings, to prevent more serious illnesses and disease. “Your swift action is essential to continuing this important, cost-effective program,” CMA President Ruth Haskins, M.D., wrote in a letter to the California Congressional Delegation. “The health of California’s children depends on your immediate action.” September 27, 2017 General Federal Legislation, Federal Legislative Advocacy, Maternal and Child Health, State Children's Health Insurance Program 0 0 Comment Read More »
California congressmen introduce bills to address physician shortage Two important bills have been introduced in Congress to address our state’s serious physician shortage and improve access to care in California. The first bill, the Training the Next Generation of Primary Care Doctors Act of 2017 (HR 3394), would reauthorize for an additional three years the Teaching Health Center Graduate Medical Education (GME) program that was established by the Affordable Care Act (ACA). The Teaching Health Center program is a community-based primary care physician training program that has been extremely successful in expanding the physician workforce in underserved areas. This bill would also expand the number of residency positions available within existing teaching health centers and establish sustainable funding. This bill has bipartisan cosponsorship by California Congressmen Raul Ruiz, M.D. (D-Palm Springs), Jeff Denham (R-Modesto) and David Valadao (R-Fresno). The second bill, the Comprehensive Additional Residency Expansion Act (HR 3451), introduced by Congressman Jeff Denham (R-Modesto) and sponsored by the California Medical Association (CMA), would build on HR 3394. The Teaching Health Center GME program currently supports 742 residents at 59 teaching health centers. This bill would add an additional 240 residency slots to train new physicians and authorize 10 new teaching health centers. It would also require the new teaching health centers be located in areas with a disproportionate share of Medicaid patients to help alleviate physician shortages and access to care in underserved regions. These bills are critically important because California is experiencing a severe shortage of primary care physicians, particularly in the rural and Central Valley regions of the state. Our state has one of the lowest primary care physician to patient ratios in the nation. Only 10 percent of physicians practice in rural areas nationwide, although 25 percent of the population resides in these regions. Training more physicians to meet the growing demands of an aging population with multiple chronic conditions is a CMA priority. We support efforts to encourage more physicians to practice in underserved areas to improve access to care. The underserved Central Valley region of California in particular has experienced difficulty attracting and retaining physicians. Data shows that most physicians set down roots in the areas where they train and remain there after their training to care for their communities. These two bills will help to create a new generation of rural physicians and ensure that patients in those areas have access to essential preventive and primary care to diagnose and treat health problems early. These are important bills that represent a practical approach to improving the physician shortage crisis and access to care challenges in California’s underserved areas. August 9, 2017 General Federal Legislation, Federal Legislative Advocacy , Graduate Medical Education, Physician Workforce, Primary Care, Rural Health, Underserved Communities 0 0 Comment Read More »
U.S. Senate health reform update While there has been considerable activity in the Senate over the past week, plans for bringing a health system reform bill to the floor for a vote remain very fluid. Under pressure from both President Trump and a long legislative to-do list, Senate Majority Leader Mitch McConnell has said he would attempt to bring repeal legislation to the floor again tomorrow. At this point, it appears that two substitute amendments for the House-passed American Heath Care Act (AHCA) are likely candidates to serve as the basis for Senate debate: A revised version of the Obamacare Repeal and Reconciliation Act (ORRA), vetoed by President Obama in 2015, that eliminates the individual and employer mandate penalties, as well as all insurance premium subsidies and Medicaid expansion funds; or The Better Care Reconciliation Act (BCRA), which was updated last week to include additional funding for opioid addiction treatment and for market stabilization, among other changes. It is unclear whether the Senate will be able to garner the 50 votes to move any health care legislation at all. To date, enough Senators have expressed opposition to either substitute to block its consideration, though negotiations are ongoing. California Senators Dianne Feinstein and Kamala Harris are opposed to both bills. Moreover, the Senate Parliamentarian issued a blow to Senate Republicans on Friday by opining that the following provisions cannot be included in a reconciliation bill: Defunding of Planned Parenthood, abortion restrictions on tax credits, repeal of the essential health benefits and the health plan medical loss ratio, and finally, the continuous coverage provision (which is the Republican alternative to the individual mandate). Given the California Medical Association’s (CMA) objectives for health system reform, CMA has serious concerns with both Senate proposals. CMA does not support repeal legislation without a replacement. CMA's position remains rooted in its policy, which supports expanding access to affordable and meaningful health insurance coverage and preserving the Medicaid safety net. CMA objects to the current proposal because it would cause nearly 4 million Californians to become uninsured, impose $114 billion in cuts to California’s Medi-Cal program over the next decade, and not help low- to moderate-income families afford insurance. CMA has called upon Congress to engage in bipartisan discussions with physicians and other health care organizations to improve our health care system and ensure access to high-quality, affordable care and coverage. In a bipartisan move, a group of moderate Democrats, led by California Congressman and Sacramento physician Ami Bera, M.D., released a plan last week to improve the Affordable Care Act. They are calling on Congress to come together across party lines to provide stability in the health care system. July 24, 2017 General Better Care Reconciliation Act (BCRA), Federal Legislative Advocacy, Health Care Reform, Obamacare Repeal and Reconciliation Act (ORRA) 0 0 Comment Read More »
