With Congress in the middle of a heated debate on how to repeal the Affordable Care Act (ACA), former U.S. Rep. Joseph Heck, DO (R-Nev.), addressed members of the Orthopaedic Political Action Committee (PAC) at the PAC luncheon during the AAOS Annual Meeting last month in San Diego.

“Nothing really is happening in D.C.,” joked Orthopaedic PAC Chair John T. Gill, MD.

Before introducing Dr. Heck, Dr. Gill provided members with updates from the Orthopaedic PAC—the only national political action committee in Washington, D.C. dedicated solely to representing orthopaedic surgeons before Congress. In the 2016 election, the Orthopaedic PAC participated in 32 U.S. Senate races and 231 U.S. House races, winning an unprecedented 94 percent of those races. As Dr. Gill explained, this enables AAOS to better know and have relationships with members of Congress, which in turn helps us be better advocates. 

According to Dr. Gill, the Orthopaedic PAC is strong, raising more than $3.5 million dollars last election cycle, but peer-to-peer education will be key in retaining and recruiting members. He encouraged those in the audience to ask their colleagues about PAC membership and suggested sharing the mobile donation option, which requires just a single text message and credit card information to donate. Orthopaedic surgeons can text AAOS to 41444 and follow the simple prompts to make a contribution. Resident involvement is important too, said Dr. Gill. He noted that more than 330 residents joined the PAC in 2016 and highlighted the upcoming resident reception, during which those residents and the leadership will have the opportunity to get to know each other.

Dr. Gill also discussed the importance of having physicians in government and pointed to recently confirmed U.S. Health and Human Services Secretary and Sen. John A. Barrasso, MD (R-WY), as examples. The Orthopaedic PAC hosts a workshop in Washington, D.C., that educates and helps elect orthopaedic surgeons and other specialty physicians to political office at all levels. The 8th annual workshop will be held April 29–30, and registration is complimentary for PAC donors.

Dr. Heck, who served as the U.S. Representative for Nevada's 3rd congressional district from 2011 to 2017, echoed Dr. Gill on the need for physicians to be active in politics. Political advocacy goes deeper than writing a check, Dr. Heck explained—advocacy requires engagement. Doctors are used to responding when there is a crisis, but Dr. Heck insisted that doctors must stay continually engaged in political advocacy in order to avert the crisis. Being proactive is important, especially with healthcare reform being a “big issue” right now.

“Government either does something for you or it does something to you,” Dr. Heck said.

Government regulates, licenses, and reimburses in addition to legislating prescribing practices. Just because you do not take an interest in politics and government does not mean government will not take an interest in you. For that reason, Dr. Heck said, it is important to return to your practices and get those who are not engaged to become members of the Orthopaedic PAC.

Dr. Heck also discussed today's political landscape and what might lie ahead for healthcare reform. The only piece of legislation being considered is the House bill, called the American Health Care Act. In explaining what the legislation includes, Dr. Heck highlighted the following three areas: repeal, keep, and add.

According to Dr. Heck, the bill repeals the mandates, actuarial requirements, taxes, subsidies, and eventually Medicaid expansion. However, it keeps the ban on preexisting exclusions, the dependent coverage to age 26, and no lifetime limits. It also “interestingly” keeps the Cadillac tax, he said.

Finally, the bill also adds expanded Health Savings Accounts, age-related and income-limited refundable tax credits, and Medicaid caps. Dr. Heck explained that these provisions are included specifically because they allow the bill to use the reconciliation procedure, which only takes 51 votes in the Senate. Still, he noted that the Senate moves at a “glacial” pace, and it will be unlikely that the House bill can pass the Senate in the same form.

Although Dr. Heck was skeptical that medical liability could get done at the federal level, he referenced legislation approved by the House Judiciary Committee last month. The Protecting Access to Care Act reforms medical litigation laws in order to reduce the costly practice of defensive medicine and save taxpayers billions of dollars while increasing access to health care. Introduced by Rep. Steve King (R-IA), the Protecting Access to Care Act is modeled after proven reforms already in place in Texas, California, and many other states around the country that have had a positive effect on increasing access to care and keeping healthcare costs affordable for patients and physicians. Medical liability and other healthcare reforms like association health plans would come in another phase, or “bucket,” after the reconciliation bill, explained Dr. Heck. Still, he acknowledged that the House has mapped out an “aggressive agenda.”

“I agree with what Speaker Ryan said that this is the last greatest hope on earth to effect some kind of repeal and replace,” said Dr. Heck. “Whether or not the American Health Care Act is the best vehicle, I don't know.”

Elizabeth Fassbender is the communications manager in the AAOS office of government relations. She can be reached at fassbender@aaos.org