HeadWise Volume 4, Issue 3 | Page 18

Legislating for Headache

Larry Charleston, IV, MD, FAHS
Headache and Medicine
Assistant Professor
Department of Neurology
University of Michigan
Ann Arbor, Michigan

Q

uality measurements, prevention of
chronic
diseases,
patient-centered
homes, small business tax credit, reporting of
health care insurance, hospice reform, limiting
and elimination of physician-owned hospitals,
health care exchanges, health insurance
mandates, accountable care organizations,
annual fee on health insurance providers,
excise tax on indoor tanning services, and an
estimated $570 billion dollar tax increase on
Americans by 2019. What do all of these have
in common? POLITICS!
Essentially, the topics stated above are
included in what was called H.R. 3590
(House Resolution 3590), otherwise known
as the Patient Protection and Affordable Care
Act (PPACA), and frequently described as
ObamaCare. Whether you agree or disagree
with PPACA is not the focus of this article.
However, the question and statement above
helps to support the idea that politics play
a major role in the administration and
regulation of health care services and delivery.
Political decisions have a phenomenal impact
on the practice of medicine, health insurance,
and the payment of medical services. Patients
need competent providers who, in addition
to providing high quality patient care, will
advocate for change when they recognize
injustice in clinical practice. As the sixth
President of the United States, John Quincy
Adams, once said, “Duty is ours, results are

God’s.” Because, I believe in that statement
and to advocacy within the political process,
I decided to obtain “hands-on” experience
within the political process as a Congressional
Legislative Fellow.
After completing a neurology residency
at Baylor College of Medicine, I finished a
one-year fellowship in the management of
headache and facial pain disorders at the
Jefferson Headache Center in Philadelphia. My
legislative fellowship was spent during the first
session of the 112th Congress in Washington,
DC. This opportunity was awarded through
the Kenneth M. Viste Jr. Neurology Public
Policy Fellowship (NPPF) that is provided
by the American Academy of Neurology
Professional Association (AANPA), which
includes specifically the American Academy
of Neurology (AAN), the Child Neurology
Society (CNS), and the American Neurological
Association (ANA). The NPPF was completed
in partnership with the American Academy for
the Advancement of Sciences (AAAS) Science
and Technology Policy Fellowship program,
which was started in 1973 in an effort to
provide education and outreach experiences for
scientists and engineers while simultaneously
providing scientific and technical expertise to
policy-makers.
I was oriented within the AAAS Science
and Technology Policy Fellowship Program
which provided opportunities for professional

development, education, and networking through
the AAAS. The AAAS served as a significant and
valuable resource during my fellowship.
During my year at Congress, I interviewed with
several offices and committees within the U.S.
House of Representatives (HOR) and Senate. The
office of Representative Wally Herger ®– California)
office and the House of Representatives Ways and
Means (WM) Subcommittee on Health, chaired
by Congressman Herger, (The current chair of the
House Ways and Means Committee is Rep. Paul Ryan
[R-Wisconsin]), were ideal for my experience, due
to a great fit for me based on a variety of factors,
including my background, their needs, our values,
etc. The House Committee on Ways and Means is
the oldest committee of the United States Congress
and is the chief tax-writing committee in the HOR.
The WM Committee exercises jurisdiction of
revenue related to Medicare and the Social Security
system. To better understand the WM Committee,
please visit the website,
www.waysandmeans.house.gov/About/History.htm.
Prior to my fellowship, I participated in several
grassroots and advocacy groups as they relate to
the fields of headache and neurology. However, it
is important to note that this fellowship was not a
‘lobbyist’ position. In fact, my role was similar to
that of a staff member. I should note that within
Congress, the word “staff” encompasses “personal,”
“committee,” and “subcommittee” staff. Personal
staff work within the Member’s district, state, and
District of Columbia offices. During the 110th
Congress, more than 14,000 individuals worked
as staff. Committee and subcommittee staff are
associated with a particular committee within
Congress.
My main area of concentration or what we called
“portfolio” on the Hill (“Hill” refers to Capitol
Hill) included sustainable health care solutions,

articulation, reform, and implementation. The
goals I established for my fellowship are listed in
the Table:
Dr. Charleston’s Goals for
Legislative Fellowship – Team Herger
• Assist Team Herger in reaching their health
care policy goals with excellence for the
112th Congress.
• Understand the current physician payment
formula, strengths, weaknesses, and proposed
alternatives.
• Understand Medicare hospital payment and
ambulatory center formulas.
• Effectively and strategically communicate
with health provider, insurance, hospital,
and industry organizations.
• Relate real life health care provider and
patient experiences to legislative ideas.
• Help introduce a Medicare Reform Bill.
• Introduce a Physician Payment Reform Bill.
• Understand tax code involving health care
issues.
• Provide assistance to Ways and Means
Subcommittee on Health.
• Effectively network with legislators, staff,
and health care authorities.
• Enjoy this con gressional fellowship to the
max!

Understand how Congress works

Throughout the year, I reviewed books, legislation,
Congressional Research Service reports, Medicare
Payment Advisory Committee reports, proposals,
columns, etc. It was important to understand the
culture of not only my office and subcommittee,
but of Congress, the federal government, and
Washington D.C. As an active member of Team
Herger, I staffed meetings, participated in speech
writing, updated Rep. Herger on current key

©“US Capitol West Side” by Martin Falbisoner

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