I have recently returned from a trip to Washington, DC for a urology advocacy meeting, where I participated in countless discussions regarding health policy. The trip culminated in a day of lobbying on Capitol Hill.  When I return back to work after a trip like this (this is the sixth year that I have participated), I am often asked by colleagues, “Why are you wasting your time?”  I don't agree that I am wasting my time; I feel that action is better than inactivity. I believe that participation by physicians in the health care debate is critical to the survival of health care in the US.  We addressed three important issues during my trip: the Affordable Care Act legislation, the anti-PSA sentiment by the United States Preventive Services Task Force and the Independent Payment Advisory Boards, created by ACA.

The future of health care in the United States is now in the hands of the Supreme Court.  Last week the court completed listening to arguments on the constitutionality of the Patient Protection and Affordable Care Act (ACA).  Much of the discussion centers on the law requiring Americans to purchase health care insurance, or the individual mandate. Numerous states have expressed opposition to this clause, claiming unconstitutionality, leading to the lawsuit that has been filed. 

One question surrounding this debate is if the states that are opposed to ACA are able to sue at the present time, as the question remains whether or not the penalty that is going to be imposed is a tax. If it were deemed to be a tax, then the question of whether the lawsuit can occur prior to the tax being levied becomes a pertinent issue – this was the content of the first day of arguments, held March 26, 2012.  

Another aspect of this bill that is being questioned is the affordability of this new legislation. The Republicans have hopes that the bill is completely overturned, however it does not seem likely that the Supreme Court would completely overturn the entire bill, but that they would instead repeal portions of it.  This ability to separate different parts of the law was the basis for the third day of arguments in the Supreme Court. 

As part of the Republican campaign agenda, the leading presidential candidates have been discussing their plans to change the ACA. The debate over the ACA will certainly be a hotly debated topic while we are in the midst of a Presidential election year and regardless of the decision, this law will play a very large part in the upcoming election. The Supreme Court is scheduled to render their opinion in June….stay tuned!

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On October 7, 2011, the United States Preventive Services Task Force (USPTFS) issued a draft recommendation against PSA-based screening for prostate cancer for healthy men stating that there is “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits” and discourages the use of the test by issuing a Grade D rating.  This rating would result in PSA testing not being covered by insurance companies.  This recommendation is something that organized urology is contesting.