Moving PCHETA on Capitol Hill: A Q&A with the Academy’s Lobbyist

Years of Academy effort to develop legislation that expands opportunities for interdisciplinary education and training in palliative care paid off last summer when the Palliative Care and Hospice Education and Training Act (PCHETA) was introduced in Congress by Sen. Ron Wyden (D-OR) and Rep. Eliot Engel (D-NY-16). (Access a summary of the bill.) In March 2013, Sen. Wyden and Rep. Engel – PCHETA’s congressional champions – were joined by Rep. Tom Reed (R-NY-23) and additional cosponsors in reintroducing the bill (H.R.1339/S.641) in the new Congress, and they need stakeholders to help move PCHETA forward on Capitol Hill.

AAHPM Public Policy Committee Chair Stephen A. Leedy, MD FAAHPM, spoke with Sue Ramthun, a principal and senior vice president with Hart Health Strategies, AAHPM’s DC-based lobbying and consulting firm, about the bill’s chances in Congress and how individuals can help grow support for the measure. (Read more in the Summer 2013 issue of AAHPM Quarterly.)

Now that the bill has been reintroduced, what are the prospects for it passing?
An Act of Congress is no easy task. It takes a lot of education and attention to compete with the thousands of bills introduced each Congress. In the last Congress (2011–2012), 10,444 bills were introduced in the House and Senate, while 283 new laws were enacted (2.7% of the total). However, the statistics are deceiving, because legislation rarely passes on its own. Rather, bills are packaged together in a broader theme. Either way, it is important to build momentum and keep your eye on the goal. The introduced legislation is your vehicle for educating members of Congress about you, your patients, and palliative care workforce needs. Seeking support for PCHETA builds visible support so, when the opportunity presents itself, there are Members of Congress to push it over the finish line and know that people back home are watching.

What does it mean that the bill includes an “authorization” for appropriations ($49.1 million/year for 5 years)?
An authorization is the legislative term for giving permission in the law for a federal agency to spend money. Authorizations typically outline the amount of money that can be spent, for what purpose, and who may receive the money. In this case, up to $49.1 million in 1 year. The actual funding is determined through the annual appropriations process. There is no guarantee that a program is fully funded up to its authorized level. The appropriations committees may take into consideration whether a program is unauthorized, meaning it was never authorized or that its authorizing authority has expired. Entitlement programs, like Medicare and Medicaid, are treated differently since they are considered mandatory spending. However, discretionary health programs (e.g., National Institutes of Health, Centers for Disease Control, and public health programs) are subject to the authorization and annual appropriations process.

Some members of Congress say they won’t support a bill that adds to the federal budget. How do we address these concerns?
Congress is living under different budget rules than in the past. Currently, federal programs are subject to across-the-board cuts (sequester) to bring spending to the previous year’s level. Members of Congress are asked to support a plethora of worthy programs important to their constituents. Congress is required to offset increased spending with comparable reductions in other programs to pass a bill. Therefore, some Members are reluctant to support legislation that does not identify spending cuts in other programs. On the other hand, it’s difficult to find an offset that is easily supported by all. Therefore, it is imperative to educate, educate, educate—and support your arguments with data. A clear need must be articulated to change policy, with data to document the workforce shortage and resulting effect on patient access. That message is stronger coming from constituents so Members of Congress know of interest back home.

What can individual AAHPM members do to help advance this legislation?
Advocating for PCHETA is a shared responsibility. You can help by sharing your experience and stories. You are the constituent, the patient advocate, and the expert. Your Representative and Senators need to hear from you. The time you take from a busy practice is appreciated and makes a statement. Although it is nice to meet with your Representative and Senators in Washington, DC, there are many other opportunities to speak up without leaving your home or office. You can call and leave a message for the Member or ask to speak to their health legislative assistant. You can e-mail (regular mail is not as timely) via the AAHPM Legislative Action Center. Members of Congress work in their district or state office about 1 week each month and are there many weekends. You can request time to meet with them during the District Work Periods or attend a Town Hall meeting or other event in which your Member participates. Check out their websites and sign up for their e-mail updates to learn of local events and opportunities. You can also invite your Members of Congress to visit your practice. This is a very effective way to directly show them what you do and the effect on patient care. As physicians and other providers on the front lines of patient care, your direct communication and outreach to congressional offices helps them to better understand palliative and hospice care and the need to ensure an adequate workforce to meet current and projected needs. Developing these personal relationships with Members of Congress and their staff takes time, but results in a much better understanding of palliative care and its importance in the continuum of care.


Access the Academy’s Legislative Action Center, and contact your representatives to ask that they sign on as supporters of PCHETA. Send an e-mail that combines your personal experience with hospice and palliative care and a few of the suggested talking points AAHPM has provided. If your members were cosponsors last Congress but have not yet signed on, you can send them a message expressing your gratitude and your hope that they will again support the bill now that it has been reintroduced. (Find out if your senators were past cosponsors here, and find out if your representative was a cosponsor here.) Share this link with any of your colleagues, and ask that they too weigh in with their members of Congress – you don’t have to be an AAHPM member to use the Academy’s Legislative Action Center.

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