The American College of Rheumatology has always stood for affordable and accessible healthcare coverage for the 54 million Americans living with rheumatic diseases. We are concerned the discussion draft of the Better Care Reconciliation Act introduced by Senate leadership this morning falls short of that goal. We stand ready to work with the Senate leadership to address these concerns.
Amid the ongoing debate in Congress concerning the future of the Affordable Care Act (ACA), the ACR has been clear about the provisions that would need to be included in a replacement bill to ensure Americans continue to have access to comprehensive and affordable rheumatologic care. Among them: protections for Americans with pre-existing conditions, coverage of essential health benefits for services particularly valuable to arthritis patients, and affordable premiums with low deductibles and minimal cost sharing. Though there are elements in the Senate bill that we find promising, the ACR still believes that it does not go far enough in ensuring these protections.
We support the Senate bill’s prohibition on states opting out of the ACA’s community rating requirements, however the bill still allows states to waive the law’s essential health benefits and many of its consumer protections. If these provisions are waived, healthcare coverage could become unaffordable for those with pre-existing conditions, including arthritis. We propose that moving forward, the Senate should include a special exception from state essential health benefit waivers to protect individuals with chronic conditions from price discrimination.
While we are pleased to see that the Senate bill includes tax credits based on age rather than income, as was the case with the House version, the ACR believes that these do not go far enough in ensuring individuals living with rheumatic disease will be able to maintain their current level of coverage. While tying tax credits to age would make it easier for older Americans to qualify, the bill also caps them at an income threshold that is lower than the one stipulated by the ACA. This would make it more difficult for middle-income Americans to receive the financial support they need to pay for coverage.
The ACR supports the Senate’s decision to include an appropriation for cost-sharing subsidies through 2019. These payments are vital to maintaining stability in the individual insurance marketplace and ensure that low-income Americans are afforded smaller out-of-pocket costs. It is the uncertainty around these payments that prompted some insurers to increase premiums while others were forced out of the marketplace altogether. As the Senate moves forward with this legislation, we will continue to assess the bill language and its potential effects, as well as the forthcoming score from the Congressional Budget Office. The ACR hopes to work with members of the Senate to address these concerns so that the millions of Americans living with rheumatic diseases can continue to access the care they need.
What You Can Do
Senate leadership has indicated they will vote on this legislation next week, and the Congressional Budget Office is also expected to release its assessment of the bill early next week. Now is the perfect time to email your Senators about the AHCA. You can quickly use the ACR’s Legislative Action Center to send a pre-filled, editable message to both of your Senators. You can also call U.S. Capitol Switchboard at (202) 224-3121 to be connected with their offices.
Sharad Lakhanpal, MBBS, MD, is in private practice at Rheumatology Associates and a clinical professor of internal medicine at the University of Texas Southwestern Medical School, both in Dallas, where he has lived and worked since 1986. He is also the 80th president of the ACR (2016–17).