Today the House of Representatives voted to repeal the Affordable Care Act (ACA) in what is viewed as largely a symbolic action because the Democrats control the Senate and President Obama would veto a straight repeal in any event. I think meaningful compromises that would improve the bill are available, but it is unclear whether today is the just the start of Republican health policy efforts in the 112th Congress, or the pinnacle. Time will tell.
During the repeal vote, across the Potomac in Crystal City, Va. a 28 person negotiated rulemaking committee (I am a member of the committee) that was created by the ACA was diligently working on one small piece of the nitty gritty of implementing the law: considering changes to how the federal government identifies Health Professional Shortage Areas (HPSA) and Medically Underserved Areas/populations (MUA/P). These designations make local areas and populations eligible for special resources to help address shortages of primary care providers (like the National Health Service Corps, Medicare physician bonus, etc.) and/or extreme health care needs (Community Health Centers, Rural Health Clinics, etc.).
The means of designating HPSA and MUA have been largely unchanged since the 1970s. The Clinton Administration attempted to revise these methods, but the proposed changes were rejected during the federal rulemaking process as constituencies affected by the changes revolted. The Bush II administration also tried to revise these methods, with the same result.
The ACA stipulated the creation of a negotiated rulemaking committee that is based on the notion (and a statute) that you bring different stakeholders together to work on difficult issues, with the government agency in question (in this case the Sec of HHS) agreeing to use the solution developed by the committee as the new rule for how these designations are done if the committee can reach consensus. The idea is that interest groups will feel represented by the process and therefore accept the new rule (though there is no guarantee of this result).
Serving on the committee has been an interesting experience. It has been time consuming and complicated because of the many issues with which we have to grapple. At times it has been frustrating, yet I believe we are making progress toward an improved designation process.
However, regardless of the final outcome of our work, the highlight for me has been meeting people with different backgrounds from all over the country who are unified in a simple goal: to improve the health of those with poor access to primary care, and to improve the lives of those with unique health problems that would otherwise be unaddressed. Even when I have not understood the perspective or position of a colleague, or disagreed with someones position, I have never doubted their commitment to trying to best use the finite resources our nation has for these purposes in the best possible manner. And I have learned a great deal from these committed people. I am hopeful we will achieve a consensus by early Summer, when our work is to wrap up.
Here are my thoughts on the first two days of the January 2011 meeting.
September 2010 meeting day 1, day 2.
October 2010 meeting day 1, day 2.
November 2010 meeting day 1, day 2.