Almost one year into my term on the ACR’s Political Action Committee, RheumPAC, I’m looking back and reflecting on what led me here. My early career was focused on learning the basics of clinical practice and building relationships with healthcare providers. Shortly after I completed my fellowship, I established goals to improve access to care for children and adults in East Tennessee, join the conversation on the Merit-Based Incentive Payment System (MIPS) and reimbursement changes, and play a role in state-level education and legislation. The only way to accomplish these goals was to establish relationships with legislators: I chose to do that through RheumPAC.
Pediatric Access in East Tennessee
My goal of improving pediatric access began in North Carolina, where I had additional training in pediatric rheumatology. East Tennessee had never before had a formally trained pediatric rheumatologist, and opening the pediatric clinic proved to be an eye-opening experience: Within the first 60 days of opening, our practice had a 10-week waiting period. Children with juvenile arthritis, dermatomyositis, macrophage activation syndrome, lupus, chronic relapsing multifocal osteomyelitis, uveitis and juvenile ankylosing spondylitis have now established care in our clinic.
These children need a physician, but they also need a legislative advocate, which is one reason I am active in RheumPAC. State and federal legislators have the ability to improve or derail our goals. In Tennessee, 50% of births occur under the state’s Medicaid program, TennCare, and over 50% of children receive their healthcare through the TennCare program until the age of 18. Under the Affordable Care Act, 31 states expanded their Medicaid programs, allowing 11 million individuals to receive additional medical coverage. Recently, the Congressional Budget Office found the proposed House version of the American Health Care Act would leave 23 million individuals without health insurance over the next decade, partially through cuts to the Medicaid program. RheumPAC has been actively working to ensure our legislators are aware of the damage the proposed bill would do to our patients.
In the state of Tennessee, children living with rheumatic disease are in constant uncertainty of access due to these legislative swings.
This situation of limited pediatric access is not isolated to East Tennessee. An estimated 300,000 children are living with juvenile arthritis, but eight states do not have a board-certified pediatric rheumatologist and five states have only one. That said, states with limited pediatric access do have the ability to expand access through the Pediatric Specialty Loan Repayment Program (PSLRP), which offers up to $50,000 of loan repayment in return for two years of clinical practice. Such programs as the PSLRP provide the opportunity to promote improved access nationally, but the program needs more advocates to accomplish that goal.