Douglas Huynh, JD, Director, Congressional Affairs, APhA
I like to tell people that being a lobbyist is a learned trait. There is no formal education that prepares you for this. There are no webinars you can attend or classes you can take. Lobbying, at its core, is about the ability to communicate and read people. At the forefront of this is filtering through the fluff to get to the substance. Ask any lobbyist, and they can probably tell you that they can tell how a meeting will go within the first 2 minutes of the conversation. Sometimes folks on the Hill tell you things they think you want to hear, so it’s my job as a lobbyist to determine what is fact and what is fiction.
I bring this up because over the first few months of this Congress, we had the prospect of reconciliation hanging over our heads. President Donald Trump’s One Big Beautiful Bill took center stage and left many congressional offices in a holding pattern as the primary focus was on passing the budget bill. It was often difficult to determine if a congressional office was sincere with its assertion that it could not review new health care policy because they were held back by reconciliation. Alternatively, it was often difficult to determine if a congressional office was sincere when they would advise us that there was an opportunity to include new health care policy in the package.
As a refresher, reconciliation is a legislative process used to enact major tax and spending legislation, which requires only a simple majority vote to pass. With that said, conceptually speaking, reconciliation should only address spending and revenue. However, that certainly doesn’t prevent language from getting in there that might not seem to fit that mold. This reality is both good and bad. It’s bad in the sense that having language incorporated into reconciliation might prove difficult because of the stringent budget rules. However, it can be good in that collaborators might be able to incorporate language into a vehicle that would not otherwise be utilized.
In this instance, we found an opportunity to include the Ensuring Community Access to Pharmacists Services (ECAPS) Act into the reconciliation package. Often we talk about needing a “legislative vehicle” for the advancement of a piece of legislation, and reconciliation is a classic example of a vehicle that would have perfectly fit this mold. ECAPS, as you know, would provide for Part B Medicare reimbursement of certain pharmacist services evolving around some upper respiratory illnesses. While ECAPS had already been introduced in the House, the reality is that the legislation would not move without the help of a larger vehicle.
Based on conversations we held with congressional committee leaders, we aligned everything up to have ECAPS as part of the One Big Beautiful Bill, even securing a Congressional Budget Office score. If included, ECAPS would likely have become law, paving the way for pharmacists across the country to finally be recognized as Medicare Part B providers.
On July 4, the president signed into law the reconciliation package, which included a permanent extension of the tax rates Trump originally signed into law in 2017, increased the child tax credit, and raised the state and local tax deductions. What it didn’t include was ECAPS. Why? It essentially came down to math. And politics. Congress was handcuffed by the president’s insistence that the reconciliation bill be very narrowly focused and exclude any health care provisions, ECAPS being one. The other issue was, of course, cost. At the end of the day, neither chamber had enough political clout to push for many health care provisions that were already part of the conversation in prior drafts, especially if it did not include any offsets. As we’ve said before, sometimes politics gets in the way of policy. And, in the case of reconciliation and ECAPS, it brought this notion clearly to life.