As Budget Deadline Looms, Former Congressional Aides Talk Health Policy at Conference

As the federal government faces another potential shutdown, a panel of former Congressional staffers shared their perspectives at AcademyHealth’s National Health Policy Conference about lessons learned on Capitol Hill.

The panel was moderated by Michelle McMurry-Heath, MD, PhD, worldwide vice president for regulatory, preclinical, and clinical affairs and global head of evidence generation at Johnson & Johnson. The group had barely had time to digest news from late Monday night that House GOP leaders had added defense demands to a continuing resolution (CR) that needs to pass by Thursday. Without the CR, the government will shut down for the second time in under a month.

At stake are community health centers, which provide healthcare for 27 million Americans, and would close if Congress does not continue funding.

The continuing budget battles “make it difficult for agencies to be good partners,” said Elizabeth Murray, MA. Now a partner at Tarplin, Downs and Young, she previously was senior health policy advisor to House Democratic Whip Steny Hoyer, D-Maryland. Hoyer is scheduled to address the policy conference later Tuesday afternoon.

“I underestimated how much people in the real world like predicatibility,” said Dan Elling, MA, now a principal at the Lincoln Policy Group. Elling previously served as former Staff Director of Ways and Means Health Subcommittee in the U.S. House of Representatives, and has advised several Republican representatives.

Murray said it is difficult to legislate when issues outside the realm of traditional budgeting are bogging the process down. “Congress has stepped away from traditional legislating,” she said. Since they won’t have straight up-or-down votes on issues such as immigration, they get forced into appropriation bills, and it is a process no one expects to end, the panel agreed.

McMurray-Heath asked if that then changes how organizations advocate for their members.

“It’s important to find members who are willing to lay on the tracks for something,” said Elling. “Finding the right champions can really have an impact.”

The Johnson & Johnson executive asked about their thoughts about the Affordable Care Act (ACA).

Elling said the ACA would always do a good job of getting people coverage. The affordability piece was not addressed much as it should have been, but that was also the most difficult piece to address, he said.

“Answers to hard questions become much harder to answer when it is 1 party attempting to answer them alone,” said Murray.

Were there any great ideas about affordability that did not make it into the ACA that didn't get included or should have been included, McMurray-Heath asked?

“We have no good ideas,” Elling said jokingly, which prompted audience laughter. Elling noted that critiques of GOP alternatives to the ACA were that premiums would go up in the short term and cover fewer people, while increasing copays and coinsurance to address affordability concerns.*

Saying “we’re going to make healthcare more affordable by limiting the benefits that you have,” may be realistic but will not sell, he said.

The panel also discussed research and pricing.

Sara Love Rawlings, a former staffer with the Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services and Education and now head of her own consulting firm, said one area that has bipartisan support is basic science research to the National Institutes of Health.

Elling said he hopes there is negotiation on Medicare Part B reimbursements, especially looking at reforming payments for physician-administered drugs.

*Edited to reflect additonal context.