In the 118th Congress, many small bills passed only if attached to major, must-pass funding legislation. Unfortunately for rheumatology, the funding legislation itself was in jeopardy in 2024 more than usual, and many of the policy priorities we fought to get attached to budget packages did not make it through the legislative culling that defined this year of Congress.
Despite this, we did see some victories and progress in 2024.
- In March, the ACR and other medical specialties succeeded in having a partial fix to the 2024 cut to the Medicare Physician Fee Schedule (MPFS) passed for the remainder of the year.
- In the FY2024 funding bill, the ACR secured:
- A second year of funding for arthritis research through the Department of Defense’s Congressionally Directed Medical Research Program (CDMRP);
- A significant funding increase for the National Institutes of Health (NIH); and
- An extension of the Conrad 30 program to help address the workforce shortage by allowing foreign-trained physicians to enter the U.S. healthcare workforce after residency completion.
- In June, the ACR and other select physician associations made up a working group convened by the Senate Committee on Finance, led by Senators Mark Warner (D-Va.), John Thune (R-S.Dak.), Debbie Stabenow (D-Mich.), John Barrasso (R-Wyo.), Catherine Cortez Masto (D-Nev.) and Marsha Blackburn (R-Tenn.), to discuss the best strategy to update the Medicare Access and CHIPS Reauthorization Act (MACRA) and reform the system for physician reimbursement under Medicare.
- Also in June, the Ways and Means Committee held a hearing, “The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine,” acknowledging the crisis with which ACR members are all too familiar.
- To add to a productive June, legislation to reform the use of prior authorization requirements was introduced. The Improving Seniors’ Timely Access to Care Act was introduced with strong bipartisan support and 45 senators and 130 representatives as original cosponsors. Reforming prior authorization has been a top priority of the College since the legislation’s first introduction in 2019.
- In October, 213 bipartisan congressional leaders showed their support for physicians by sending a letter urging House Speaker Mike Johnson (R-La.) and Minority Leader Hakeem Jeffries (D-N.Y.) to support legislative action to address “damaging” payment cuts to physicians in the 2025 MPFS Proposed Rule.
The final budget package was the last chance in 2024 to move the policies that had momentum. Unfortunately, the week before Christmas, negotiations regarding a year-end package were disrupted after President-elect Donald Trump publicly announced his opposition to how negotiations were proceeding. Several of the ACR’s priorities were included in the initial package negotiated by congressional leadership. However, after four days of tense negotiation, Congress passed a stripped-down package to fund the government through March.
The ACR ended 2024 incredibly disappointed that this long-negotiated package does not include several crucial policies that would improve access to care for patients and instead:
- Only extended Medicare telehealth flexibilities through March (versus a two-year extension in the original bill), risking barriers for the most vulnerable patients and disruptions in operations;
- Allowed a 2.8% cut to Medicare reimbursement to go into effect (versus a 2% mitigation in the original bill, still down from the substantial reforms advocated for by the College);
- Omitted substantial reforms to the business practices of pharmacy benefit managers that were included in the original bill and promised savings in the billions to the healthcare system; and
- Failed to address administrative burdens by including language reforming prior authorization requirements or step therapy protocols.
2025 is a new year with a new Congress. We have another chance with a budget bill in March. Many of these items remain fresh in the minds of returning legislators and language and one-pagers about these issues are already being introduced to those in their first term.
The work continues—you can push these policy priorities forward by contacting your legislators directly through the legislative action center or contributing to RheumPAC to facilitate the College’s support of rheumatology champions in Congress.
