Greetings from your advocacy team in Washington, D.C.!
The tectonic plates of the U.S. political landscape continue to shift. The latest: President Trump fired FBI Director James Comey on Tuesday, May 16; since then, Congress and journalists have had very little bandwidth for much else. But healthcare advocates remember just several news cycles ago when Congress passed a budget that boosted NIH biomedical research funding by $2 billion; the day before that, the House passed the American Health Care Act, or AHCA (and here I thought it was a zombie, neither dead nor alive). Meanwhile, at the executive branch, the last major health administrator is in place after Scott Gottlieb, MD, Commissioner of Food and Drugs, was sworn in Wednesday, May 17, as FDA Commissioner.
Deciphering the AHCA
For those of you who didn’t read the whole healthcare bill (don’t worry, neither did more than a few members of Congress), here is a quick recap of what the AHCA would do if it became law:
- Repeal mandates to buy insurance, replaced with a penalty for not maintaining continuous coverage;
- Replace the income-based subsidy with age-based tax credits. With age, premiums can rise out of proportion to credits;
- Allow states to obtain waivers that remove essential health benefits and preexisting condition protections;
- Change Medicaid from direct federal funding to a block-grant system and end Medicaid expansion;
- Allocate $115 billion (+8) for high-risk pools; and
- Keep the protection for kids to stay on their parents’ plans until age 26.
A few unique things about the bill: First, the House didn’t score the final bill to see what it would cost before voting on it, and second, after it passed, House Republicans celebrated in the White House rose garden. These actions suggest the bill was more of a political maneuver to keep campaign promises than an actual attempt to effect change. And that’s where things get a little messy.
A new poll shows only 21% of Americans support the bill the House passed. Given its unpopularity, it’s not surprising that Senate Democrats are staying away from ACA reform efforts, and Senate Republicans claim to be starting from scratch and working at a Senate pace, not a House pace with healthcare reform. We are hearing that the Senate might write a bill by August.
Meanwhile, on Wednesday, May 17, Aetna announced that it will pull out of exchange plans in 2018. Humana had already pulled out. On Thursday, President Trump threatened to stop the somewhat controversial but highly stabilizing cost-sharing reduction payments from the Treasury to insurers (approximately $7 billion/year). So there is a lot of uncertainty about the state of the Obamacare statutes, as well as the actual marketplace, as we near the June 2017 deadline for insurers to apply to participate in 2018 exchanges.
ACR Hill Visit
Amid the Obamacare chaos, the ACR Board of Directors and volunteers from several key ACR committees hand-delivered a letter from ACR President Sharad Lakhanpal to Senators on Wednesday during our spring Hill visit. The letter lists key health reform principles the ACR supports, including continuous, affordable insurance coverage; reimbursement for services that people with arthritis and rheumatologic diseases need; and protection from preexisting condition exclusions. We also reminded legislators about the importance of protecting rheumatology practices by repealing IPAB and providing tort reform.
Aside from discussing health reform, ACR leaders lobbied Congress about two other critical topics:
- Reducing the rheumatology workforce shortage through loan forgiveness, increasing GME slots and streamlining international physicians’ visas to work in areas with shortages; and
- Creating a permanent stand-alone arthritis and rheumatology research fund at the Department of Defense.
Important: Visit the ACR Legislative Action Center to quickly send a message to your senators to address concerns regarding adequate coverage for people with chronic conditions. (Apologies to my fellow D.C. residents—no Senators.) While you’re there, click the boxes to send notes to your members of Congress about other timely issues. It’s easy and fast!
It’s been a successful legislative session for rheumatology advocates in many state houses. There are new laws in the following categories:
- Biosimilar notification: 31 state laws in total, including five in 2017;
- Step therapy: 12 state laws, including two in 2017, plus Iowa, which is pending the governor’s signature; and
- Reduction in out-of-pocket costs: in New Hampshire, a bill to prevent drug companies from giving copay assistance was defeated; and in Washington, D.C., a new law caps specialty copays at $150/month.
You can easily get involved in politics closer to home in state issues by signing up at the ACR’s State Advocacy page or by contacting your local rheumatology society.
Join the AMA
You probably already know that this is a critical year in which the ACR must count in its ranks 1,000 AMA members in order to continue to magnify our voice through the AMA. But did you also know that when you sign up or renew your AMA membership, you can win free registration and hotel accommodation for the ACR/ARHP Annual Meeting in San Diego? Do it now! With enough members, the ACR will continue to propose that our initiatives become AMA policy and, therefore, gain more traction. Currently, the ACR is considering AMA resolutions to garner government support for increasing GME positions for the first time since 1996 and streamlining visas for international physicians.
Angus Worthing, MD, FACP, FACR, is a practicing rheumatologist in the Washington, D.C., metro area and clinical assistant professor of medicine at Georgetown University.