Congress Can Begin Work to Advance Rheumatology Before New Year

What to expect this December & into the 114th Congress

Because many larger decisions that affect rheumatology and patients were put off by Congress until after the November elections, the “lame duck” session between the elections and the convening of the new Congress may take on special importance. With a new chairman, new members and new party powers entering in January, the time is now for this Congress to have an impact on critical issues and for offices to prepare for action in 2015. Here are some developments that may affect rheumatology toward the end of this Congress and into the next.

Medicare Advantage Networks

During the recess, two identical bills were introduced in the House and Senate to address recurring issues with Medicare Advantage plans. Senator Sherrod Brown (D-OH) and Representative Rosa DeLauro (D-CT) put forth bills that would require Medicare Advantage plans to finalize their networks 60 days prior to enrollment and prevent the providers from dropping physicians during the middle of the year without showing cause. The ACR is working closely with a coalition of diverse healthcare providers and the bill sponsors to push this legislation forward in a timely manner.

Specialty Tiers

Many recent studies have suggested that spending on specialty drugs will account for half of all pharmacy spending in the next four years. Although the ACR has been pushing this issue for some time, Congress, insurers and manufacturers are now taking serious note. Progress on this issue looks more promising, with plans to reintroduce the Patients’ Access to Treatments Act early next Congress and strong possibilities for a Senate sponsor. The ACR is meeting with the Coalition for Accessible Treatments this month to plan for the next Congress, and we continue to work closely with the bill sponsor to gather more support from legislators.

Funding for Biomedical Research

There is a dire need for increased funding at both the NIH and CDC. The Ebola outbreak has shed light for legislators on the need to fund research ahead of a crisis. The ACR continues to push for a more robust NIH budget for 2015, asking for $32 billion in appropriations. We were pleased that Rep. DeLauro introduced a House companion bill to Senator Tom Harkin’s (D-IA) Accelerating Biomedical Research Act. The ACR has sent letters of support for this bill, which would allow for increased NIH appropriations. Further, we are watching closely after a strong push to maintain funding for CDC arthritis programs. Expect a long-term funding package during the lame duck session.

SGR/Payment Reform

Although Congress has acted to prevent the drastic SGR cuts from taking place, passage of a permanent repeal of the flawed formula is still much awaited by all provider groups. The ACR has worked closely with leading physicians in Congress who are pushing hard for this legislation. There will be an effort to pass SGR repeal during the lame duck session, but more than likely, we can anticipate action later on, in the next Congress.