Government Affairs: A Marathon, Not a Sprint

As my tenure on the ACR Government Affairs Committee (GAC) draws to a close, I have been ruminating on the pace of change in government. It has been both a challenging and a satisfying experience. One of the most frustrating things about contacting your elected representatives, even when you visit them in person, is that you almost never get a promise to take immediate action on an issue. Frequently, your senator or representative (or their staff) will promise to look into the issue. Then, on a long flight home, you wonder if all your effort was a waste of time.

Some analogies from my career as a clinician, educator and researcher make me take a more positive view.

As a teacher, especially in a classroom setting, I wonder at times if I have gotten through to a class at all. Were the students really listening or caring about the material, or were they bored and distracted by their electronic devices? Yet at the end of a course, at graduation or even much later, I often meet students who say they really did use the material in practice. Sometimes they will even say, “You were my favorite teacher, and you inspired me to pursue a similar career.”

In patient care, it is often difficult to know if we made a difference until time passes and our patient has made a slow, but real, improvement.

And in research of course, we may run into such roadblocks as missing a grant, slow progress on work, long review times for a research article or outright project failure. But we continue, nonetheless.

Donald Miller, PharmD

And so it is in lobbying your representatives: It is not one email or one visit on the Hill that makes Congress take an action, but the slow, cumulative impact of hundreds of constituents’ contacts.

The Long View

From my current perspective of Capitol Hill visits over six years, I find it interesting to realize how much legislative action has actually occurred on issues of importance to the ACR and ARP.

In just the past three years, legislation has passed on the following issues that we have brought to the attention of Congress:

• In August 2022, the Inflation Reduction Act capped Medicare Part D out-of-pocket costs at $2,000 annually.
• The FY2022 Congressional Funding Bill funded the pediatric loan repayment program for the first time.
• In September 2022, the Improving Seniors’ Timely Access to Care Act passed the House, prompting the Centers for Medicare & Medicaid Services (CMS) to adopt its provisions into a rule it published in 2023.
• In March 2024, the Conrad State 30 and Physician Access Reauthorization Act passed. This extended the Conrad 30 program, which allows J-1 foreign medical graduates to apply for a waiver of the two-year foreign residence requirement upon completion of a J-1 exchange program.
• Also in March 2024, the National Defense Authorization Act of 2024 included a line item for arthritis research in the Congressionally Directed Medical Research Programs at the Department of Defense.

In Sum

Advocacy has its challenges, but overcoming them with the support of colleagues and friends is incredibly satisfying. Never underestimate the impact of contacting your representatives, and focus on long-term results.

I encourage anyone in the ACR and ARP to volunteer for the GAC or leverage the tools available in the ACR Legislative Action Center to send an email to your representatives. Your actions do make a difference.

You can also get involved in your state or local rheumatology society or donate to RheumPAC to really stretch your advocacy efforts.

Donald Miller, PharmD, is professor emeritus of pharmacy practice, North Dakota State University, Fargo. He has served on the ACR Committee on Rheumatologic Care, the Government Affairs Committee and the ARP Executive Committee.

Author’s note: Thanks to Lennie Shewmaker McDaniel, JD, ACR director of Congressional affairs, for details on recent legislation.