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The 118th Congress: Updates to Guidelines and Management

April 22, 2023

May 2023

Camille Puronen, MD, MPH

Camille Puronen, MD, MPH

The American Society of Hematology (ASH) selected Camille Puronen, MD, MPH, as its 2022-2023 ASH Congressional Fellow. The Congressional Fellow program aims to connect hematologists to the policy-making process and educate congressional members and staff about issues that are important to hematologists and their patients.


As most readers are no doubt aware, the 118th Congress got off to a dramatic start with a protracted vote for Speaker of the House. By the end of February, the dust had settled on Capitol Hill, and the work of re-establishing offices and committees had begun. Each new Congress brings a period of arrivals, departures, reorganization, and new priorities.

In the office of Congressman Brian Higgins (D-NY) in the 26th district, we are preparing our legislative agenda and updating bills for reintroduction. One of my first tasks in the 118th Congress was to re-register the bipartisan House Cancer Caucus, educating both new and returning representatives about its mission and soliciting new members. It has been incredibly encouraging to see enthusiasm and support for cancer care and research from both sides of the aisle.

Although Congress has changed, my day-to-day work remains much the same. I research and compose documents for senior office staff, draft memos and remarks for the congressman prior to meetings or hearings, attend committee hearings and Caucus briefings, and meet with constituents and stakeholders both virtually and in person. I have met with people with rare diseases requesting National Institutes of Health funding, seniors hoping to protect Medicare, teachers worried about their students’ health, patient advocates warning of barriers to care, and even particle physicists who tried to explain dark matter, in addition to nurses, providers, researchers, insurers, and hospital administrators. They bring stories, experiences, data, and proposals for letters or bills. We discuss their concerns in our staff meetings and do our best to support their requests.

Dr. Puronen (left) at a Cancer Caucus welcome event with National Cancer Institute Director Monica Bertagnolli, MD, and Rep. Brian Higgins (D-NY).
Dr. Puronen (left) at a Cancer Caucus
welcome event with National Cancer
Institute Director Monica Bertagnolli, MD,
and Rep. Brian Higgins (D-NY).

Another part of my job is researching health topics for the office. I was recently tasked with summarizing public health agreements between the U.S. and Canada. After floundering for a couple of days, I submitted a request to the Congressional Research Service (or, as I referred to them in my first column, Congressional UpToDate). A few days later, I received a detailed and comprehensive listing of all such agreements between the U.S. and Canada, categorized by topic and with annotated links, covering thousands of pages of documents. I was surprised to learn that in 2012, the U.S., Mexico, and Canada entered into a trilateral agreement called “North American Plan for Animal and Pandemic Influenza,” or NAPAPI, pledging to work together and share both data and strategy in the event of pandemic flu. Unfortunately, many of these recommendations were overlooked during the COVID-19 pandemic, and we did not enjoy the unified, coordinated response imagined in NAPAPI. Revisiting these past agreements could provide us with a starting point for creating a new, stronger framework with which to face the next pandemic.

Beyond my day-to-day activities, I have been drafting a bill to improve access to cancer screening, addressing barriers such as prior authorization requirements and cost-sharing for patients. My office introduced a similar bill in the 117th Congress and has been working on adding provisions for outreach and educational campaigns. To draft the bill, we work with staff from Legislative Counsel, a team of attorneys who take nebulous bill ideas and re-write them using legally effective language. The next time you read a bill and wonder who wrote the text, you can thank the folks at Legislative Counsel. (If you’ve never read a bill, congress.gov has you covered. Their top 10 list is a great place to start.)

The most exciting part of my job is experiencing political high drama in the form of committee hearings. There’s nothing like watching representatives question high-profile witnesses in imposing congressional hearing rooms. This isn’t a special privilege of working on the Hill – most hearings are now open to the public and available via video (again, see congress.gov). If I have time, I sometimes head to the House Gallery to watch proceedings on the floor, particularly if there is a major vote or if the congressman is delivering a “1-minute” speech, which many representatives do weekly while the House is in session.

As I write, the busy appropriations season is nearly upon us. The House and Senate are awaiting the president’s budget, which they will review and, theoretically, use to develop their own budgets. Offices have a few weeks to submit letters to the appropriations committee requesting funding for hundreds of programs. Ideally, the appropriations committee reviews their requests along with the president’s and creates a budget that is then reconciled between the House and Senate. This process is not always successful. If a budget is not agreed upon, Congress may resort to a “continuing resolution,” which simply reinstitutes the prior year’s budget until the process can begin again the following year.

I am delighted to be doing this work surrounded by smart, dedicated staffers who keep things running behind the scenes. Much like achievements in biomedicine, most legislation is built on years of hard work, determination, plot twists, and near misses. I am reminded daily of the importance of patience and creativity. I am lucky to have excellent mentorship from my office staff, who have been patient and accommodating while still having high expectations. In addition, I am always learning new things from my diverse cohort of delightfully nerdy American Association for the Advancement of Science co-fellows, who have created a lively community of scientists on the Hill. The ASH Congressional Fellowship has already completely changed the way I think about politics, health care, and science. I can’t wait to see what the second half of my year on the Hill will bring.


The content of Notes from the Hill is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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