ACR Advocacy Update 2025, Federal & State

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Chicago—In a session titled Rheumatology on the Hill: The State of Play in Washington, D.C., Christina Downey, MD, chair of the Government Affairs Committee, described ongoing committee efforts to advocate on behalf of its members a variety of ways, including its annual May Hill day in which ACR and ARP volunteers meet with members of Congress. She cited a number of legislative wins through this effort, such as winning support in an early draft of the reconciliation package for updating the Medicare Physician Fee Schedule (MPFS) annually for inflation in accordance with Medicare Economic Index (MEI), and progress on the Patients Before Middleman Act to delink pharmacy benefit manager (PBM) income from drug prices they negotiate in Medicare Advantage D plan.

One May Hill priority was to ask Congress to stop cutting NIH grants and funding. The ACR also sent letters to Congress and the Trump Administration recommending that more than 47 billion dollars be allocated to the NIH in 2026 Congressional appropriations bill, that they preserve and fund the CDC Arthritis Program, and that Congress maintain language that would prohibit NIH from implementing the proposed 15% facilities and administrative indirect cost cap.

She emphasized advocacy is nonpartisan and member driven, and shared a way members can track legislative action online.

More Federal Policy Updates

Lennie Shewmaker McDaniel, JD, the ACR’s senior director of Government Affairs and Advocacy, updated members on public policy issues affecting rheumatology practices, including cuts to Medicare reimbursement, prior authorization reform, step therapy reforms, prescription drug pricing and access to biosimilars. McDaniel also discussed advocacy efforts for more support for the medical workforce, the use of telehealth and the need for federal funding for biomedical research.

McDaniel, who led the session, said advocacy efforts are more difficult in the current climate where the margins in both the U.S. House and Senate are so thin that no new legislation is probable, and that all healthcare issues are basically on hold during the current federal shutdown. During the shutdown, she emphasized, one of the biggest concerns is to ensure rheumatology patients can still access clinical care via telehealth given it is no longer reimbursed as of October 1. “We are working to preserve access for our patients during the shutdown, but there is no predicting of how long this will last,” she said, saying the ACR is supporting a bill to re-implement telehealth access and ensure a stable and reliable reimbursement structure.

Among other priorities, McDaniel discussed the ongoing efforts to continue advocating for Medicare reimbursement. She said it is unfortunate the physician fee schedule is the only Medicare fee schedule not linked to inflation, and that the ACR is trying constantly to rectify that. She said progress is slow but the ACR is working on a bill, and she is hopeful some progress will be made on this in 2026. Specifically, the ACR seeks to increase reimbursement through the physician fee schedule by repealing sequestration cuts, repealing the balanced budget requirement and updating the physician fee schedule annually for inflation per the MEI.

McDaniel also discussed advocacy efforts to protect the 2021 evaluation and management (E/M) payment updates and recognition of the values of these services through frequent evaluations. In addition, the ACR is working with a medical specialty coalition and majority party Doctor’s Caucus on introducing legislation in 2026 to secure appropriate Medicare reimbursement and actually raise reimbursement rates, which have declined since 2020.

Another priority: vaccine access. Given clear signs of a government shift toward limiting vaccine access and away from science-based vaccine policy, McDaniel said the ACR has written a new policy statement explicitly stating the ACR supports vaccines for school-age children and immunocompromised patients and their close contacts. The policy statement also explicitly states the ACR supports payers covering the costs of vaccine access for these groups. In an earlier statement this year, the ACR stated the American public can have confidence in vaccines. The ACR has also communicated with Department of Health and Human Services Secretary Robert F. Kennedy, and urged the Senate Finance committee to pose questions about the state of the Centers for Disease Control and Prevention (CDC) during Secretary Kennedy’s testimony.

State Policy Updates

Joseph Cantrell, JD, director of State Affairs and Community Relations for the ACR, discussed advocacy for the same issues at the state level. He first noted the large amount of anti-vaccination legislation seen in state governments this legislative session. Currently, he said, 20 states propose to reduce the uptake of the vaccines by expanding non-medical exceptions or implementing “safety warnings” based on non-scientific data. Last year, the ACR saw anti-vaccine legislation in just four states. In one big win on this front, the Arthritis Foundation challenged a Florida proposal to eliminate vaccine requirements for children in public schools, and that policy has been walked back because of the combined efforts of patient and provider groups.

Another key issue: The federal government has removed almost $1 trillion dollars in funding from Medicaid, a shared federal-state program. Cantrell said states will explore many different approaches to meet the needs of Medicaid recipients, but he said no state can afford to correct the deficit on its own. “States will face some stark decisions as they consider budgets next year,” he said.

Final Thoughts

Cantrell underscored the importance of providers and patients engaging with members of Congress and their state legislators. “Legislative offices do still listen to constituents because ultimately they want to get re-elected,” he said, adding that sending emails and making phone calls can help “move the needle.” He also urged members to register and vote in the 2026 midterm election.

Cantrell said donating to RheumPAC is the most important way rheumatologists can invest in the future of their specialty. “The PAC is nonpartisan, and it specifically supports candidates for office that align with the policy priorities of the ACR and the rheumatology community,” he said. “RheumPAC focuses on policy rather than partisanship and ensures that rheumatology champions are supported across the political spectrum.”

McDaniel said the key message for members is that advocacy makes a difference in any circumstance. “Some think government is shut down so advocacy isn’t an option, when actually it’s advocacy that lifted the hold on processing Medicare claims despite the shutdown,” she said. 

Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.