capitol hill report: Could your advocacy go even further at the state level?

By Michael Markowski, DO, FAAN

In early January, I had the pleasure of attending the American Medical Association’s State Advocacy Summit in Amelia Island, Florida, along with AAN Senior State Affairs Program Manager Grant Niver. This weekend conference confirmed that our AAN advocacy efforts at the state and federal level focus on many of the same issues as other physician groups, including the AMA: streamlining prior authorization, reforming step therapy, bolstering the physician workforce, fixing Medicare reimbursement, and much more.

Although neurology has remained approximately 2% of the physician workforce for several decades, we have a strong voice among lawmakers in Washington, DC. The AAN in particular remains a very respected physician organization by the Centers for Medicare and Medicaid Services (CMS), which seeks our input and feedback on various regulations. Our neurology footprint and presence on Capitol Hill continues to depend upon our BrainPAC donations, which I encourage you to learn more about so our collective voice continues to be heard by federal lawmakers.

Although the atmosphere in Washington has been increasingly partisan in recent years—complicating our federal efforts for various health care reforms—local state houses often have a more unified and bipartisan environment where many of our longstanding advocacy issues may be easier resolved. This AMA state advocacy conference was a terrific reminder of the old adage that “all politics are local.” In 2023, more than 20,000 bills were introduced in Washington. At the state level, that number rocketed to more than 165,000.

One example of powerful state-level advocacy can be found this past fall when the AMA and the Medical Society of New Jersey approached the AAN to help push prior authorization reform across the finish line in New Jersey. The Ensuring Transparency in Prior Authorization Act’s (A1255/S1794) intention was to enable a meaningful decrease in delays of care that lead to poor outcomes, including long response times and repeat authorizations, along with improving continuity of care when patients change their insurance. Our New Jersey neurology colleagues were thrilled when this bill passed and became state law earlier this year, bringing significant prior authorization reform to our country’s 11th-largest state and a big win for AAN advocacy. New Jersey is the 18th state to pass common sense prior authorization or step therapy reforms in recent years.

As a general neurologist in Cape Cod, Massachusetts, and Vice Chair of the AAN’s Advocacy Committee, I feel very fortunate that we have excellent staff located in Washington, DC, advocating for our patients and profession. It is much more challenging to have a physical presence in all 50 states and to remain aware of the innumerable health care bills and scope of practice bills introduced into every state legislature. That is where members come in. By partnering with our state medical and neurologic societies and leveraging our key neurologist contacts within each state, we have an opportunity to be more effective at the state level and win needed improvements before enacting similar reforms at the national level.

For these reasons, it is important to stay involved locally and learn about proposed state legislation that affects your patients and practice. Contact the AAN’s advocacy team to bring any state issues that we can assist with to our attention.

At the end of this AMA conference, we enjoyed a roundtable discussion with three neurologists who also serve as state representatives in Minnesota, Mississippi, and North Carolina. They encouraged neurologists to become more involved in state advocacy efforts and further supported our successful AAN advocacy approach—that while it is important to quickly review pertinent figures and data, the key to convincing lawmakers to act upon our behalf is by sharing our patient stories illustrating the need for health care change. We all have the opportunity and ability to share such stories.