SAN DIEGO—The 2017 ACR/ARHP Annual Meeting, Nov. 3–8, presented opportunities to highlight its 2017 legislative advocacy victories, some of which were resolved just weeks before the conference began, as well as issues that are still outstanding.
In the session, Legislative & Regulatory Update 2017, Angus Worthing, MD, chair of the ACR’s Government Advocacy Committee and an independent rheumatologist practicing in Washington, D.C., said, “A lot is happening on the advocacy front.” According to Dr. Worthing, the ACR has managed to achieve some recent successes, although one of its top priorities was to protect patients’ access to care in the face of legislative proposals to repeal the Affordable Care Act (ACA). Recent developments in D.C. suggest that some of the patient protections provided by the ACA are still in danger of repeal.
The ACR will continue to advance its concerns by working in coalitions with other healthcare advocates and focusing on the need to maintain access to care and treatment, taking issue with specific provisions of legislation rather than positions on overall bills, Dr. Worthing said. The priority is to ensure sufficient, affordable, continuous coverage that enlarges access to high-quality healthcare for all and the continuation of essential health benefits. In the ACR’s view, proposals to repeal the ACA have not gone far enough to protect that access, he explained.
Key Advances in 2017
Other important legislative and regulatory advances in 2017 for the field of rheumatology, highlighted in the session at the Annual Meeting, include:
At the ACR’s request, the American Medical Association’s House of Delegates passed a resolution requesting the overturn of a Trump administration proposal to stop allowing the premium processing of H-1B visa waiver applications for physicians in exchange for an additional fee. The administration agreed to this request just in time for newly graduated medical fellows to make commitments to jobs in underserved areas, a critical issue for rheumatologists in particular, Dr. Worthing says.
There are only 5,000 practicing rheumatologists in the U.S., less than the current need, which is estimated at 6,115 rheumatologists, and demand is expected to exceed supply by 138% by 2030.1 “One solution to the shortage of rheumatologists is for internationally trained physicians to work in underserved areas through the H-1B visa program, but the premium processing of their applications is essential if they are to commit to jobs by the June 30 academic year deadline,” said Dr. Worthing.
Other current legislation supported by the ACR and aimed at improving access to medical care includes:
- H.R. 2141/S. 898, the Conrad State 30 and Physician Reauthorization Act, which streamlines the J-1 visa program for foreign physicians to practice in underserved areas;
- H.R. 2266, the Resident Physician Shortage Reduction Act of 2017, which would create additional residency positions; and
- S. 989, the Ensuring Children’s Access to Specialty Care Act of 2017, which would make pediatric rheumatologists eligible for the National Health Service Corps’ loan repayment program.
NIH research funding
The ACR and its coalition partners were able to persuade Congress not to decrease the government’s commitment to medical research funding through the National Institutes of Health (NIH); the Trump administration had proposed a 22% decrease. The ACR hand-delivered more than 100 letters to members of Congress, and advocates met with key members of Congressional committees, including Rep. Tom Cole (R-Okla.) and Sen. Roy Blunt (R-Mo.). The committees voted instead to increase the NIH budget for the coming fiscal year (the Senate voted for a $2 billion increase, and the House voted for a $1.1 billion increase). Although at press time a final omnibus appropriations bill had not yet been enacted, drastic cuts in the NIH budget now appear unlikely.
This development is critical for the rheumatology community, some of whose members are engaged in discovering new therapies, Dr. Worthing said. In addition to the NIH budget, the ACR continues to advocate for funding the Centers for Disease Control and Prevention’s Arthritis Program, and the development of a new, $20 million dedicated arthritis research program in the Department of Defense (DoD). The ACR’s advocacy efforts have included raising Congress’s awareness of the impact arthritis has on the armed services and the importance of pursuing arthritis research through the DoD. Arthritis is the second-leading cause of medical discharge from the Army and the leading cause of disability among veterans.
The Independent Payment Advisory Board
The Independent Payment Advisory Board (IPAB), a government agency created by the ACA to push cuts in the Medicare system when spending targets are not met, was targeted for repeal by the ACR and other medical groups. A vote to repeal IPAB was passed by the House on Nov. 1, and companion efforts in the Senate had 49 cosponsors.
Cap on rehab therapy
Originally created as a healthcare cost-cutting measure in 1997, an arbitrary cap on rehabilitation therapy expenditures under Medicare during a calendar year sometimes has the effect of precluding coverage for physical, occupational and speech language therapies needed by rheumatology patients. Bills that would eliminate the cap on rehab therapies have been introduced in Congress for the past four years, and the cap is now closer than ever to being repealed. A bipartisan framework has been adopted by key committees in the House and Senate, and Dr. Worthing says, “Congressional leaders have joined together to reopen Medicare access to rehabilitation therapies.” The respective bill numbers for the Medicare Access to Rehabilitation Services Act of 2017 are H.R. 807 and S. 253.
Starting the conversation about pharmacy benefit managers
Specific legislation to address the problem of high copayments for specialty drugs, the Patients’ Access to Treatments Act (H.R. 2999), would establish cost-sharing limits and prevent insurers from using drug formulary specialty tiers to limit access to needed therapies. It has been the ACR’s marquee legislative target for the past three Congresses, and its champion, Rep. David McKinley (R-W.Va.), has introduced the bill several times. “The ACR remains committed to increasing patient access to therapies that help our patients control their potentially disabling diseases like rheumatoid arthritis,” Dr. Worthing said.
Concerns about drug pricing and the practices of pharmacy benefit management (PBM) companies, were a high priority for the ACR’s September Advocates for Arthritis Capitol Hill visits and were discussed in several sessions. Advocates’ concerns about access to high-cost drugs for their patients threatened by rebates and other PBM practices have now been taken up by Congress.
Drug pricing issues were aired in a series of hearings by the Senate Committee on Health, Education, Labor and Pensions. At a hearing in October, both Democratic and Republican committee members asked questions about high drug prices and the effects of rebates, and called for greater transparency in PBMs’ pricing practices. “These hearings are critical, because they are helping get the conversation started about PBMs,” Dr. Worthing said.
Larry Beresford is a freelance medical journalist in Oakland, Calif.
- Bernstein S. Rheumatology’s future: The 2015 Workforce Study reveals rising gap between rheumatologist supply & patient demand. The Rheumatologist. 2017 Feb;11(2):49,54–56.