On May 11, ACR leaders will fly to Capitol Hill to meet with Congressional leaders on behalf of ACR and ARHP members. With so many pressing policy issues facing the medical community this year, we hope that you, too, will let your members of Congress know where you stand on the following issues:
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Support Medical Research Funding
The ACR is fighting for $20 million from the FY2018 Defense Appropriations Bill to create an arthritis research program at the Department of the Defense (DoD) to better serve veterans living with rheumatic diseases. Arthritis is the leading cause of disability among U.S. military veterans and the second most common reason for medical discharges from the U.S. Army. Arthritis currently competes against a number of other health issues for more general medical research funds, and in the last cycle, advocates secured $16 million in grant funds for arthritis-related research proposals. The designated budget line item we are requesting through the appropriations process would secure this amount for arthritis, allowing researchers more security and resources so they may work on reducing the impact of arthritis on the armed services and the population at large.
Ask your senator and representative to: Dedicate $20 million through the FY2018 Defense Appropriations Bill to create an arthritis research program at the DoD.
National Institutes of Health (NIH) Funding
NIH-funded discoveries are the backbone of the biomedical industry. Discoveries made possible by NIH funding have led to extraordinary improvements in the lives of patients living with rheumatoid arthritis, psoriatic arthritis, lupus and other rheumatic diseases. Biologics are available today thanks to NIH funding. In addition, NIH research creates jobs, grows local economies, advances treatments and cures for disease, and reduces healthcare costs. Yet federal investment in the NIH continues to decline. Adjusted for inflation, the NIH receives nearly 25% less funding than it did in 2003, and additional cuts up to 30% have been proposed by the new administration. The NIH currently funds research in all 50 states and the District of Columbia, supporting more than 400,000 scientists at 2,400 American research institutions. This funding is great for communities: Every dollar of NIH funding generates more than double that amount in local economic growth.
Ask your senator and representative to: Support a $2 billion increase from FY2017 for the NIH in the FY2018 Labor-HHA Appropriations Bill, in addition to funds included in the 21st Century Cures Act for targeted initiative.
The CDC Arthritis Program, the only federal program dedicated specifically to arthritis, collects epidemiological data on the country’s No. 1 cause of disability. The CDC also connects citizens living with arthritis with evidence-based programs to help manage their disease.
Ask your senator and representative to: Support the allocation of $16 million for the CDC Arthritis Program in the FY2018 Labor-HHS-Appropriations Bill.
Address the Rheumatology Workforce Shortage
According to the 2015 Workforce Study of Rheumatology Specialists in the United States, conducted by the ACR, 54 million Americans—that’s one in four people—now live with arthritis, and approximately 79 million will have arthritis by the year 2040. Although the demand for arthritis care is growing, the pool of U.S. rheumatologists is shrinking as more rheumatologists retire from the profession and fewer new doctors enter the rheumatology subspecialty. According to the workforce study, the increasing demand for rheumatology care already outpaces supply, a gap that is expected to widen significantly by 2030. We are urging leaders on the Hill and in the administration to:
- Fund additional rheumatology residency positions through Medicare’s Direct Graduate Medical Education payment system;
- Support the Conrad State 30 & Physician Access Act, which would allow international doctors trained in the United States to remain in the country if they practice in underserved areas;
- Support the Pediatric Subspecialty Loan Repayment Program; and
- Preserve access to H1B visas for international medical students and professionals.
Repeal the Independent Payment Advisory Board (IPAB)
The IPAB is a 15-member board, created as part of the Affordable Care Act (ACA), tasked with achieving savings for the Medicare program by making recommendations to Congress and the president to cut Medicare expenditures if spending growth exceeds certain thresholds. Unfortunately, IPAB’s recommendations have the power to impose cuts to rheumatology providers that will disproportionally affect small and rural rheumatology practices and the patients they serve. In addition, IPAB’s statutorily mandated fast track legislative procedures mean that IPAB proposals automatically become law. The legislative branch is prohibited from modifying IPAB measures unless three-fifths of the Senate votes against the recommendations or Congress passes legislation that changes the manner in which IPAB achieves targeted savings. In addition, IPAB recommendations are not subject to executive or judicial branch review. Nearly 30% of Medicare patients are being treated for arthritis, so it is crucial that proposed cuts to Medicare not affect the ability of rheumatologists to provide care to patients; as early and consistent care from a trained specialist is critical to prevent long-term disability in people with arthritis and other rheumatic diseases.
Ask your senator and representative to: Eliminate IPAB via legislation or a joint resolution. Several pieces of legislation to repeal IPAB in both the House and Senate have achieved bipartisan support, including S.251, the Protecting Medicare from Executive Action Act of 2017, introduced by Sen. Ron Wyden (D-OR), which calls for the board’s repeal; S.J.Res.16, introduced by Sen. Ron Wyden; and H.J.Res.51, introduced by Rep. Raul Ruiz (D-CA) to authorize the board’s permanent repeal and S.260 and H.R.849, Protecting Seniors’ Access to Medicare Act of 2017, companion bills introduced by Majority Whip Sen. John Cornyn (R-TX) and Rep. Phil Roe, MD (R-TX), to rescind IPAB’s authorization.
Other 2017 Policy Priorities
- Ensure that any healthcare reform legislation prioritizes affordable coverage for chronically ill patients by
- Including coverage for Americans with preexisting conditions;
- Limiting copayments and out-of-pocket costs;
- Covering children on a parent’s insurance until age 26;
- Banning lifetime limits; and
- Applying tax credits based on income.
- Implement MACRA appropriately, which would include optimizing the Merit-Based Incentive Payment System (MIPS) for rheumatology care and supporting a rheumatology-inclusive Alternative Payment Model;
- Apply proper value to cognitive specialty care, including new ICD-10 service codes that more adequately reflect rheumatology care in reimbursement;
- Provide funding for FDA biosimilars review to ensure the introduction of additional safe and effective therapies and lower biologic drug costs;
- Limit overly restrictive insurance practices, including step therapy, prior authorization and specialty drug tiers;
- Provide adequate insurance coverage for biologic therapies, including coverage of administration for complex drugs and Medicare coverage of reimbursement at true ASP+6%; and
- Advance greater transparency of Pharmacy Benefit Manager processes and accountability in how PBMs handle negotiated savings to promote more affordable drug pricing for patients.
Remember: There’s power in numbers. You can join these ACR leaders in a Virtual Hill Day by visiting the ACR’s Legislative Action Center and letting your members of Congress know where you stand on the issues above. Fact sheets on each of these subjects is also available on the ACR’s website, so reach out to your representatives today!