The Health Record - Healthcare Law Insights, Issue 6, October 2024

Alexander Macia has practiced law for over 33 years, the last 19 of them with Spilman. Alex is the Co-Chair of the firm’s Government Relations Practice Group and, over his career, lobbied at the West Virginia state house for certain entities in the healthcare and healthcare delivery industries such as the West Virginia State Medical Association, the American Heart Association, Maximus, Delta Dental, the American Lung Association, and the West Virginia Chapter of the American College of Cardiology. In addition to his government relations practice, Alex has defended physicians, hospitals, and other healthcare practitioners in state and federal courts, as well as before their respective licensing boards.

What is the first thing you do when you get the assignment to enact legislation?

The language of any proposed bill must be fully vetted with attorneys in the respective professional healthcare organization, be it the American Medical Association, or the relevant specialty organizations, because there are many pitfalls to legislating medical practice and those organizations are positioned well to understand and guard against the potential adverse consequences of ill-defined terms or other loose language. The next step is to understand and set the expectations of the client. On average, about 2,300 bills are introduced in every annual 60-day regular session. Of that number, about 290 are enacted. This yields an annual average of 12.5 percent. With such a marginal success rate, it is imperative to be able to effectively communicate the need for the bill, line up allies who support the bill, and apply persistent pressure to ensure that it is not lost in the blizzard of bills that blanket the legislature every session.

What are the biggest obstacles to lobbying for a healthcare organization?

The genius of our state constitution is that it created a citizen legislature where teachers, public employees, coal miners, lawyers, pest control technicians, and taxi cab drivers can all serve as representatives. The flip side of that coin, however, is that there aren’t many members with medical training (there are now a total of three physicians out of 134 members). Moreover, the legal staff on the committees typically don’t have such a background. I have discovered that the best way to communicate to the members and their staff is to find a practitioner in the relevant field to be the advocate to the Legislature for the bill. A practitioner can testify that the bill is important and should enacted because it is “beneficial to my patients.” I can never say those words, so when I speak about the need for legislation, I don’t have the credibility of the medical professional with an active practice. Additionally, that person should be able to reduce the need for legislation to one easy to remember anecdote which neatly encapsulates the need for the legislation and its desired effect. A few years ago, we were advocating for a bill that recognized certain pharmaceuticals known as biologicals and biosimilars, both of which are routinely used in rheumatology. The physician who testified to the bill told the story of a particular patient who suffered needlessly for years because she could not afford the exorbitant costs of biologicals and how that case nagged at the physician because there did not appear to be any relief for her patient. The bill she advocated permitted pharmacists to dispense interchangeable biosimilars to patients in much the same way that generics are now routinely dispensed for name brand pharmaceuticals. The story of the patient suffering for rheumatism became the quick anecdote which could be recounted to legislators running between meetings or even bites of lunch.