Advocacy Successes
Physician Advocacy Successes
Good health policy is made with physicians in the discussion.
MSDC, working with its members, partners, and other organizations, has won major policy victories to help its members practice medicine. Below is a sampling of those victories. Do you want to be a vital part of the next policy victory helping improve the health of the District? Contact us today.
Opioid Policy
- MSDC was added to the opioid fund oversight panel by the Council in its legislation authorizing the oversight body
Scope of Practice
- MSDC supported legislation to ban the sale of flavored electronic smoking devices and restrict the sale of electronic smoking devices.
- Working with a coalition, MSDC added funding to the DC budget to support the hiring of more license specialists to help with the delay in processing medical licenses.
Women's Health
- B24-143, to regulate certified midwives, passed the Council with MSDC's support
Health Equity
- Mayor Muriel Bowser signs into law the Electronic Medical Order for Scope of Treatment Registry Amendment Act of 2019. The eMOST Registry Amendment Act permits the creation of an electronic database of advanced directive wishes for District residents that can be tied into the health information exchange.
- Mayor Bowser signs into law the School Sunscreen Safety Temporary Amendment Act of 2019. The bill permits students to bring and apply sunscreen during the 2019-2020 school year.
- MSDC comments on the importance of funding United Medical Center (UMC) and health facilities in Wards 7 and 8 in the mayor's budget. Those comments are used almost verbatim in CM Trayon White's comments advocating for funding of United Medical Center.
Scope of Practice
- DC Health publishes draft regulations removing the 3 mandatory CME hours for HIV/AIDS awareness and replaces them with a requirement to fulfill 10% of mandatory CME hours with a topic from a public health priority list. DC Health then waived the requirement for 2020.
- The Strengthening Reproductive Health Protections Act of 2020 is signed into law with MSDC support. The bill prohibits government interference in reproductive decisions between a patient and doctor, and prohibits employers from penalizing physicians for practicing reproductive medicine outside of their work hours.
- The Mayor's Commission on Healthcare Systems Transformation releases its final recommendations. One recommendation is for the District to explore options to make providing health care more affordable, including financial relief for higher malpractice insurance rates.
- The Council removes "telephone" from the list of prohibited types of telemedicine to allow physicians and other providers to be reimbursed for telephone telemedicine appointments after MSDC and health community advocacy.
- MSDC worked with the Council to modify onerous language in the Health Care Reporting Amendment Act that potentially would have penalized physicians from seeking help for substance abuse or addiction issues.
Opioid/Drug Policy
- The Department of Health Care Finance (DHCF) waives prior authorization for key medication assisted treatments (MAT) treating substance use disorder patients in Medicaid.
- The Mayor signed into law The Access to Biosimilars Amendment Act of 2019, a top MSDC priority as it would help prescribers to prescribe more cost-effective drugs for patients.
Behavioral Health
- The Behavioral Health Parity Act of 2017, a major priority for MSDC and DCPA, officially becomes law. The legislation requires all health benefit plans offered by an insurance carrier to meet the federal requirements of the Wellstone/Domenici Mental Health Parity and Addiction Equity Act of 2008.
Health Equity
- The District Council passes B22-1001, The Health Insurance Marketplace Improvement Amendment Act of 2018. The bill prohibits the sale of Short Term, Limited Duration health plans and Association Health Plans (AHPs) in the DC Health Benefits Exchange.
Scope of Practice
- DC joins 28 other states in the Interstate Medical Licensure Compact with B22-177 becoming law. The IMLC is designed to ease physician licensure in multiple states.
Women's Health
- The Maternal Mortality Review Committee is established by law. The Committee is responsible for finding solutions to maternal health crisis in the District. District physicians are an important part of this vital committee.
- B22-106, The Defending Access to Women's Health Care Services Amendment Act, becomes law. The act requires insurers to cover health care services like breast cancer screening and STI screenings without cost-sharing.
Opioid Policy
- Right before the Council adjourned for the session, it passed B21-32, the Specialty Drug Copayment Limitation Act. The bill limits cost shifting by payers for prescription drugs.
Behavioral Health
- B21-0007 passes the Council. The Behavioral Health Coordination of Care Amendment Act of 2016 permitted the disclosing of mental health information between a mental health facility and the health professional caring for the patient.
Women's Health
- MSDC was proud to have worked on B21-20. The law requires payers to cover up to 12 months of prescription contraception, advancing women's health and equality.
Advocacy Curriculum: How a Bill Becomes a Law
An important part of successfully fighting for your cause is knowing how your issue becomes law. If you have watched the federal gridlock over the past few years, you may think that an idea becoming law is a long, arduous, and impossible process. Local DC government can be quite the opposite although the process still has numerous steps where your bill can be tripped up.
Before going any further, the District website has an excellent primer on the legislative process. If you want a succinct source on this subject, bookmark this page. What follows builds on the Council’s description of its process and adds real-life perspective.
A bill is introduced. Every bill is filed with the Secretary of the Council by a Councilmember. Prior to filing, a Councilmember may seek co-introducers who names appear atop the bill. After the bill is introduced, the bill may be cosponsored by Councilmembers during the legislative meeting.
In a twist, while a Councilmember files a bill, the Mayor and “charter independent agencies” may introduce bills before the Council. Their bills are introduced through the Chair of the Council. You will frequently see this when the Mayor nominates someone to a Board, or an agency has a priority or fix it wants the Council to address. See examples here and here.
The bill is assigned to a committee. Each bill, once introduced, is assigned to a committee. The Chair of the Council makes the assignments. If you watch a Council legislative meeting, you will hear the Chair announce assignments once the introducer speaks to a bill. The Chair basis the assignment on the bill’s content, action desired, and area of concern.
Some bills are straightforward – for example, a bill to require DC Health to create materials on newborn hearing screening would go to the Committee on Health. What if a bill requires a change in the health insurance industry, such as banning prior authorization? The Chair could assign it to the Committee on Business and Economic Development (which oversees private health insurance), assign to the Committee on Business and Economic Development AND Health, or assign it to one with “comments” from the other. This is an important process because a bill cannot become law without advancing from a committee. Passing one committee can be tough, and two is much tougher especially if the bill is controversial.
A prime example was a bill that permitted sunscreen to be brought and applied in schools. MSDC supported this bill but the bill was assigned to the Committee on Education because the language changed public school policy. The Committee on Education could not get enough momentum to hold a hearing and pass the bill, so it stayed stuck in committee for multiple Council periods.
The bill has a hearing and markup. If a bill has momentum, it has a hearing and a markup. A hearing is an opportunity for the public and government to weigh in on a bill, suggest changes, support, or oppose the bill. We wrote about how you can testify at such a hearing here.
After a hearing, a committee can have a markup and report the bill from the committee. The markup involves a public committee meeting, the opportunity for committee members to introduce amendments, and a vote to pass the bill to the whole Council. Each bill that passes receives a committee write-up, which is a thorough summary of the bill, testimony, amendments (if any), and impact on DC law. Here is an example of a committee report.
Council consideration. When a committee reports out a bill, the next step is on the Committee of the Whole agenda. The “COW” is a committee composed of the entire Council to consider legislation. If the COW approves the inclusion of the bill on the Council agenda, it is considered at a future Council legislative meeting. A noncontroversial bill may be placed on the consent agenda and those bills are approved en bloc. If the bill is approved at this meeting, it goes on the agenda at the next legislative meeting. During either legislative meeting, the bill may be amended and can be discussed at the discretion of the Chair. If the bill receives a majority of votes for approval in both meetings, it goes to the Mayor.
Mayoral review. The Mayor has three options when a bill is transmitted. The Mayor can sign the bill and the bill moves to the next step. The Mayor can not sign the bill and it moves to the next step. The Mayor can also veto the legislation. If the Mayor vetoes the bill, the Council may overturn the veto with a 2/3rds vote of Councilmembers at a legislative meeting. Once a bill moves past this step, it is assigned an “Act” number, i.e., the B24-111 becomes A24-1.
Final step – Congress has a say. Once the District government has its say, Congress gets its say. This is part of the whole “taxation without representation” debate and why bills take so long to go into effect. Any approved Act goes to the Congress for a review period of 30 days. This is Congress’s chance to sink a bill before it goes into effect. This rarely happens because both Congressional chambers must pass a joint resolution of disapproval, and the President must sign the resolution. Inevitably this leads to a long, unnecessary delay for a new policy to go into effect while Congress ignores a DC law, or a handful of members use a District law to raise their political profile.
Next month, we will discuss “special situations”.