Capitol Hill Report: Health Care Law and Neurology

July 9, 2012


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506–7468,

The view outside the Supreme Court as the ruling was released.

Derek Brandt and I were on the steps of the Supreme Court as the health care decision was released. It was quite a zoo with protesters from the right and left, many of them carrying a sign or wearing a costume. Many members of Congress were out as well, and ready to appear in front the roughly 100 news cameras that were ready to roll.

The health care law deals with huge issues ranging from decreasing the number of uninsured to providing coverage for those with pre–existing conditions, but my thoughts quickly turned to how it would impact the issues the Academy has been advocating for, such as improving recognition of, and access to, cognitive care providers.

I had expected that the Court would throw out the individual mandate and likely the entire bill, which would have given us a chance for a do–over on efforts to improve the practice climate of primary care providers. My hope was that if that happened we would be able to build upon our recent successes to provide better recognition of cognitive care providers as Congress rushed to re–pass popular provisions.

With the law upheld (surprisingly as a tax), it appears likely impossible to change individual provisions as the federal and state governments implement the law. I still do not see any hope that Democrats will open the law up for improvements or that Republicans would help them if they did.

So we will continue to work the halls of Congress to impact future legislation rather than trying to rewrite the past.

Packed Room for AAN Briefing on Patient Access to Biologics

Do you have any patients, friends, or even family members who struggle with the high cost of co–pays for biologics? Last week the AAN co–hosted a briefing on Capitol Hill to raise awareness of the growing trend of high patient cost sharing for biologic drugs by commercial health insurers. Reps. David McKinley (R–WV) and Lois Capps (D–CA), the co–sponsors of a bill designed to provide patients with some relief—the Patients’ Access to Treatments Act of 2012 (HR 4209)—headlined the briefing.

Nassim Zecavati, MD representing the AAN at the congressional briefing.

Georgetown pediatric neurologist Nassim Zecavati, MD, a member of the AAN’s Government Affairs Committee, explained the critical and unique role biologics play in managing medical conditions to a packed room of 60 congressional staffers and other interested parties.

Zecavati discussed her experiences with families struggling to afford costly medications and the limitations of biosimilar mediations. As the AAN’s 2009–10 Neurology Public Policy Fellow, she is very familiar with Capitol Hill, having served on the staff of Sen. Jeff Bingaman (D–NM) during the congressional debate on health care reform.

The AAN has joined a coalition to move support for the Patients’ Access to Treatments Act along with the National MS Society and the  American College of Rheumatology, who are also key partners with AAN for the advancement of appropriate Medicare reimbursements for cognitive care services.

Specifically, HR 4209 will work to stem the tide of commercial insurance policies moving vital medications (mostly biologics) into “specialty tiers” that utilize high patient cost–sharing methods. These  policies can run costs into the thousands and put necessary treatments out of reach for patients, especially those suffering from MS and other complex conditions.

Personal anecdotes carry the weight of gold in DC, so if you have any stories about your patients struggling to pay for their biologic drugs, please let me know at

Learn more about this issue.

Did Scope of Practice  Cost Oklahoma Rep Seat?

In a big upset, Rep. John Sullivan (R–OK) lost his re–election bid in a primary loss to Navy Reserve pilot Jim Bridenstine in the Tulsa–based 1st district.

For several years the physician community has supported  Sullivan, a member of the House Energy & Commerce Committee, who has been an outspoken proponent for physicians on scope of practice issues. For example, in the current 112th Congress, Sullivan is the sponsor of the Healthcare Truth and Transparency Act (HR 451), which requires disclosure of license to patients by all practitioners. This is an AMA led federal scope of  practice initiative that has already passed in several state legislatures.

This outspokenness, however, drew the attention of the optometrists who strongly supported Bridenstine in the primary where he  prevailed 54–46. Congressional candidates are required to report the names, occupation, and employer of contributors who donate more than $200 to a campaign. The optometrist stepped up in Bridenstine’s race as his report lists 66 contributors with “optometrist” as the occupation.

There’s no telling how Bridenstine, who is heavily favored to win the general election in November, will be on physician issues, but we  know that we have lost a supporter in Rep. Sullivan.

It continues to be a tough primary year on incumbents with reputations for supporting physicians. There are many issues that impact campaigns, put scope of practice on the board as another.