When President Abraham Lincoln made these remarks to Congress on Dec. 1, 1862, it was about the stormy present of a nation at war with itself, and the need to think and act differently to save the country. I was reminded of his words when I thought about the stormy present of the United States today. Like the soldiers who fought to preserve the Union in the time of Lincoln, at grave risk to themselves, it's today's physicians, nurses, emergency medical technicians, and other health care workers who are valiantly doing all they can to save our country from a highly infectious and often lethal pandemic disease, COVID-19. They are putting their own lives, and often those of their families, at great risk, and often without the protection they need, just like the ragged soldiers of the Civil War who marched unprotected against a fusillade of Gatling guns.
Our stormy present also requires that we think anew and act anew, not only in how care is organized and delivered on the front lines but also in advocating for public policies to help physicians save as many of us as possible from COVID-19 while keeping themselves safe as well. Since COVID-19 became a national and global emergency (even before the official declaration of such by President Trump), ACP has been turning out statements of advocacy at an unprecedented pace, constantly thinking anew about what else needs to be done—today, not tomorrow—to support physicians and their patients.
In the one-month period from March 3 through April 3, ACP released 41 letters, statements, and policy pronouncements on COVID-19, all of which (and additional ones since then) can be found on our coronavirus advocacy page. It's not just the astonishing number of policy recommendations we've put out that's noteworthy, it's all the activity that accompanies them: the calls and virtual meetings with members of Congress and their staffs, with federal agency officials, with private payers, with our allies, with anyone who can make a difference for the better.
It's also that we've had to think anew about issues that we've never had to address, or never had to address in circumstances like we have today. ACP has been taking on the really difficult issues, leading the national conversation and bringing others along with us, from advocating to oppose discrimination in care against classes of patients and against physicians and others of Asian descent, to doing everything possible to get personal protective equipment (PPE) to physicians, to issuing social distancing recommendations, to urging that actions be taken to address growing shortages of prescription drugs.
In particular, ACP has been advocating for policies on the following.
- Ensure the supply, distribution, and rapid dissemination of PPE to physicians and other frontline workers. We were, to my knowledge, the first physician membership organization to urge President Trump on April 2 to use the Defense Production Act to require companies to manufacture PPE. The president subsequently announced a partial invoking of that authority to require that 3M produce masks and other PPE, although ACP continues to press him to apply this authority more broadly.
- Ensure the economic viability of struggling physician practices. As physicians have switched to virtual visits rather than in-person ones, they've taken a huge hit on the revenue needed to keep their practices open and pay their staffs. ACP has advocated successfully for CMS to pay for phone calls under the Medicare program and has urged private payers to do the same (many have). We've advocated successfully for provisions in COVID-19 legislation from Congress to provide direct payments to practices, allow them to apply for low-interest “forgivable” loans for payroll and other related costs, make them eligible for advance tax credits to offset expanded paid medical and sick leave, and much more. We've been pressing federal agencies to prioritize physicians and get the help they need out the door, as quickly as possible. More still needs to be done, however, and ACP will continue to do all that it can to ensure that physicians and their practices get the support they need.
- Ensure that patients are covered for testing and treatment and that both are affordable. We've pressed for more funding for and expansion of Medicaid coverage, for coverage of tests and related physician visits at no cost to the patient, for creation of a specialty enrollment period in the Affordable Care Act's health plan marketplaces, and for coverage of telehealth and audio-only phone calls to the many patients who do not have smartphones and other video-sharing telehealth devices.
- Ensure that international medical graduates can get the visas they need in time to travel to the United States for their residency programs.
ACP has also created a toolkit for members, continually updated, to help them obtain the help that they and their practices need.
ACP will continue to advocate on these issues, and on whatever challenges come up, as quickly and effectively as needed, to address the stormy present of COVID-19, thinking anew and acting anew so we can help save our country from this deadly virus.