What’s Really Going On in D.C. Right Now and What We’re Doing About It

Last week I told you that the Academy had begun a busy advocacy agenda. Even since then, there’s been a lot of activity in the Capitol, so I’m writing to update you about where things stand.

New Congress

The 119th Congress convened Jan. 3 and kicked off what the body always does in its opening few weeks: Lawmakers iron out committee assignments and put the finishing touches on their legislative priorities. When a new Congress coincides with a new presidential administration, the U.S. Senate also carries out its important “advise and consent” role, overseeing cabinet and agency appointments made by the incoming president.

As it always does at such times, the AAFP’s Government Relations staff is right now in direct conversation with the key committees working on the administration’s health care nominations, including the Finance Committee and the Health, Education, Labor and Pensions Committee. In these conversations, we are focused on several important themes, including the qualifications we believe are necessary for these positions.

Historically, the AAFP has neither endorsed nor objected to cabinet or agency appointments. The Academy recognizes the importance of working productively with whomever is ultimately confirmed. However, we see it as our responsibility to remind the Senate of our values and, when appropriate, articulate where those values contrast or conflict with a nominee’s known positions. To do this, we have provided questions for lawmakers to consider asking during their hearings with two goals in mind:

1. obtaining responses on issues of importance to family medicine to ensure that answers are heard and on record, and

2. reminding members of these committees that we intend to hold them accountable for thoroughly vetting the nominees.

Again, irrespective of the outcome of these nominations, the AAFP will engage with whomever assumes these roles and will continue to lift up the critical role family physicians play in the care you deliver to your patients and the communities you serve.

Presidential Transition

Every four to eight years, the United States goes through one of the greatest experiments of our democratic system, the transition of the presidency. On Jan. 20, Donald Trump was sworn in as the 47th president — and only the second in history to secure a non-consecutive second term. (The first was Grover Cleveland.)

Any change of administration produces some disruption. Right now, some things that appear chaotic are in fact consistent with transition-period norms. Let me clarify how.

Every president since the creation of our democratic system has initiated a series of executive actions within hours of assuming office. These come in the form of “executive orders,” and they serve a few purposes. First, they are, collectively, a vehicle to outline the overall stance of the incoming administration. Second, and in line with that positioning, such orders sometimes reverse executive orders made by previous presidents. Third, they can serve as broad rulemaking and guidance for the federal agencies under the authority of the executive branch.

It's important to say that executive orders have been used by all presidents, and that these actions are subject to legal interpretation; in some cases, they exceed presidential authority and are overturned.

Beyond recent executive orders you’ve seen covered in the news in recent days, other actions by the new administration have caused confusion but nevertheless don’t depart radically from precedent. These include a freeze on publishing pending regulations in the Federal Register, a temporary halt to external agency communications and a federal hiring freeze. These steps allow the incoming president to get a handle on the core functions of government, including political appointments and staffing. With the change of administration generally comes the departure of about a thousand personnel; those positions take time to fill.

Ahead of Jan. 20, the AAFP team closely monitored the presidential transition. Many of the executive orders announced in the first hours of the new administration were in line with reports we had received as the inauguration neared. We are carefully reviewing each order to understand their policy impacts and, more specifically, their implications for family physicians. It is through this process that we determine — now, as we have when working with past administrations — whether and how we will respond, and by which levers of advocacy.

Advocacy Engagement

One such lever is big and basic and should be a comfort to AAFP members: Policymakers understand and value the Academy as a trusted source on health care and health policy. This is particularly true across the regulations and laws that affect the specialty of family medicine and its role in the nation’s primary care health care system. We achieved this position in large part because we take a careful, deliberative approach to our advocacy — always with the goal of ensuring that the Academy has a seat at the table.

Our Government Relations team follows criteria to determine our engagement on critical policy issues and employs an array of tactics. These include direct lobbying, coalition engagement, public communications and member advocacy. Absence of public engagement doesn't mean were not working on an issue. Some of our greatest advocacy often occurs in ways that go unseen by the public. Know that our advocacy conveys the AAFP’s values and views, and works to see them incorporated into policy without jeopardizing other areas of focus. We are judicious about how and when we weigh in with legislators and regulators so can we preserve our authority and exert maximum influence to shift policy.

Lawmakers and regulators are not always going to agree with our stances on key policy issues. We do not shut the door on those individuals because of those differing viewpoints. In a democratic system of government that allows for a broad range of viewpoints and differing philosophies, the art of advocacy is being able to offer education and shape thinking as we work to bring understanding. Practicing this art over the long term, we are able to shift viewpoints and find opportunity.

Meanwhile, it remains our goal to take into account the perspectives of all our members. When we achieve this, we are united as the specialty of family medicine.

To learn more about what we’re doing — and to get involved in advocacy yourself — follow the links under this post and be sure to read an update from AAFP President Jen Brull, M.D., FAAFP.