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February 15, 2017

Why doctors in Congress are gaining clout

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Physicians in Congress say they bring a unique patient perspective to health care policy, and their voices are becoming increasingly influential amid ongoing debate over the Affordable Care Act (ACA), according to observers.

Historically, there have been few doctors in Congress: Between 1960 and 2004, only 25 of more than 2,000 congressional representatives were doctors, according a JAMA study. There were eight overall in 2004, and today, Congress has 14 physician lawmakers (not including Tom Price, the former House representative who was recently confirmed as HHS secretary).

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Ashish Jha, director of the Harvard Global Health Institute, said the growing economic and political importance of health care is driving more doctors to run for office. "As health care has become a larger and larger part of our economy, you've seen more and more interest among political leaders in regulating and shaping health care," he explained. "A lot of doctors… who for decades have had a lot of autonomy have felt it's kind of time to push back and get involved."

Political makeup

Doctors in Congress have long-skewed Republican, according to the JAMA study. The study found that between 1960 and 2004, 60 percent of physician lawmakers were Republicans compared with 45.1 percent of all other lawmakers. Rep. Michael Burgess (R-Texas), who is currently the most senior physician in Congress, said it's "not an accident" that most doctors in Congress are Republicans. "Doctors tend to be fairly conservative and are fairly tight with their dollars," he said.

But surveys suggest the political makeup of doctors currently in Congress doesn't mirror the broader medical community. For instance, according to a recent Medscape survey, about 55 percent of doctors voted for Hillary Clinton in the last election—while just 26 percent voted for Donald Trump. And "national surveys show doctors are almost evenly split on support for the health law," NPR's "Shots" reports.

GOP physicians' voices

Observers say it is clear physician lawmakers are playing a key role in guiding health care policy. Robert Doherty, a lobbyist for the American College of Physicians, said, "As political circumstances have changed, they have grown more essential."

And several Republican physicians are well positioned to influence upcoming health care policy debates, according to NPR's "Shots." For instance, Burgess chairs the House Energy and Commerce Subcommittee on Health; Sen. Bill Cassidy (R-La.) sits on both the Senate Finance and the Health, Education, Labor and Pension Committees; and Sen. John Barrasso (R-Wyo.) chairs the Senate Republican Policy Committee.

More broadly, Rep. Phil Roe (R-Tenn.), who co-chairs the GOP Doctors Caucus, said physician lawmakers have more influence over health care policy because of their professional backgrounds.

Roe said his priorities for an ACA replacement include scrapping the individual mandate and the law's essential health benefit requirements, such as mental health and maternity care.

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And since the beginning of the year, Burgess has proposed two health care bills focused on expanding health savings accounts and bringing more maternity-care providers to areas facing a shortage of such providers. He's also steered "fiery, impassioned hearings about curbing spending in the $550 billion Medicaid program," Bloomberg reports.

During a Feb. 1 House subcommittee on health hearing, Burgess said his background as a physician made him uniquely qualified to weigh in on Medicaid reform. "As a physician, I have had the privilege of actually providing health care for hundreds of Medicaid patients," he said. "I have looked in their eyes, I have listened to their concerns, I have held their hands, and I know many of their stories."

Barrasso, who says he wants to give patients more control over their care, also indicated that he wants to roll back much of the ACA. He contended that under the ACA, people in his home state had to give up their preferred providers and plans to meet the ACA's essential benefits requirement—and that their premiums and deductibles increased.

Cassidy, meanwhile, is "aggressively pitching his vision with a newly introduced bill dubbed the Patient Freedom Act of 2017," according to Bloomberg. His proposal would expand health savings accounts, implement insurance reforms, and keep several popular provisions of the ACA, such as protections for individuals with preexisting conditions. Like Barrasso, Cassidy emphasizes that he wants to give patients more control.

Democrats and critics

Rep. Ami Bera (D-Calif.)—like Republican physician lawmakers—said his physician background also gave him a unique, valuable perspective on health policy. "You'll find a lot of doctors talking about health care in the language of patients and see a lot of staff on health care committees talking about it in the language of policy," he said. "You have to have both, but you can't have really good policy unless you understand how it's going to impact patients."

However, Bera said it seemed like some of his Republican colleagues "take the business approach to health care, the old school practicing doctor… who's running the group practice," instead of adopting the patient perspective that he said he employs.

Separately, Rep. Raul Ruiz (D-Calif.) cited his "firsthand experience of seeing the face of failed policies"—particularly for the uninsured, middle-class, seniors, and veterans who cannot afford care or face long wait times—as part of the reason he opposes the GOP's rhetoric around health care reform. "That face will only get more bleak and gloomy if Republicans repeal the ACA," he said. 

Meanwhile, Jha said he hopes that over the long term, Democratic and Republican physician lawmakers can find more common ground. "I find the incredibly deep split frustrating because there are two competing interests (among doctors in Congress)," Jha said, citing the desire for universal coverage and Republican lawmakers' concerns about "how much government intrusion there is into medicine." But he added, "Most of us who are physicians feel like we want both" (Pelham, Bloomberg, 2/10; Galewitz, "Shots," Kaiser Health News/NPR, 2/10; Finnegan, FierceHealthCare, 2/13).

Navigating the first 100 days of the Trump administration


Since Donald Trump won the presidential election in November, health care reform has since quickly risen to the top of the GOP's policy agenda—and heath care executives are grappling with a new sense of uncertainty.

While many unknowns will remain across the next few months and potentially even years, the first 100 days of the Trump administration will provide significant insight into the direction of reform efforts. Read our briefing to learn what five key issues you should watch.

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