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Legislative landscape affecting rheumatology has potential wins but many challenges


 

AT ACR 2017

 

A variety of legislation that’s currently under consideration in Washington has great potential to affect the field of rheumatology and its patients, but ongoing efforts to advocate for the specialty and patients are showing signs of paying off in some areas, Angus Worthing, MD, said at the annual meeting of the American College of Rheumatology.

Dr. Angus Worthing is chair of the ACR’s Government Affairs Committee and a practicing rheumatologist in the Washington area
Dr. Angus Worthing
Legislation in Washington that the ACR and its allies are trying to influence include bills that address the anticipated workforce shortage in rheumatology, replacements or changes to the Affordable Care Act, federally funded medical research, and access to affordable drugs and rehabilitation services.

Dr. Worthing, who is chair of the ACR’s Government Affairs Committee and a practicing rheumatologist in the Washington area, encouraged rheumatologists to become involved in advocacy efforts and asked members of the audience at the meeting to visit the ACR’s advocacy website to learn how to help.

The ACR supports a group of bills that have been introduced in either the House or Senate that should have an effect on alleviating the projected shortage of rheumatologists across the United States through 2030. These bills will help, although much of the effort to address the shortage and maldistribution of rheumatologists across the United States will “probably be solved at the local level. It’s not going to be a federal solution. It will be relationships and treatment programs between primary care and rheumatology care that are very local,” Dr. Worthing said.

The Conrad State 30 and Physician Access Reauthorization Act (H.R. 2141, S. 898) aims to streamline visas for foreign physicians to practice in underserved areas.

The Resident Physician Shortage Reduction Act of 2017 (H.R. 2267) would increase for the first time since 1997 the number of graduate medical education residency slots in the United States.

The Ensuring Children’s Access to Specialty Care Act of 2017 (S. 989) allows pediatric subspecialists, including pediatric rheumatologists, to get access to the National Health Service Corps loan repayment program when they work in underserved areas.

More recently, in spring 2017 the American Medical Association played a big role in getting the Trump administration to reverse its stance on not allowing premium processing of H1-B visas for professionals such as physicians. If this had gone into effect, all the rheumatology fellows in training who were going to be practicing – some in underserved areas – might have been forced to return to their home country because of a lack of time to get their H1-B visa processed before finishing their fellowship, Dr. Worthing said.
 

Affordable Care Act (ACA)

U.S. Capitol Alicia Ault/Frontline Medical News
The ACR supported none of the four versions of bills introduced in Congress that have sought to repeal and replace the ACA because they did not go far enough to ensure access to care, Dr. Worthing said. It’s unclear whether any current bipartisan ACA marketplace stabilization bills will see enough support as well as make it to a vote, and it’s also possible in 2018 to see a revival of similar repeal and replace legislation, he said. However, the ACR has outlined its stance on such bills, saying that it would support bills that:
  • Provide sufficient, affordable, continuous coverage that encourages access to high-quality care for all.
  • Prohibit exclusions based on preexisting conditions.
  • Allow children to remain on parent’s insurance until age 26 years.
  • Remove excessive administrative burdens that take focus away from patient care.
  • Cap annual out-of-pocket costs and ban lifetime limits.
  • Have affordable premiums, deductibles, and cost sharing.
  • Continue the 10 essential health benefits that are required for ACA marketplace plans.

Alliance for Transparent & Affordable Prescriptions (ATAP)

The ACR convened this alliance along with the Coalition of State Rheumatology Organizations, the Global Healthy Living Foundation, the Association of Women in Rheumatology, the Rheumatology Nurses Society, and others to try to bring transparency to how pharmacy benefit managers (PBMs) operate in getting certain drugs on the formularies of payers. The ATAP recently had some success in making lawmakers aware of the PBM’s role in influencing drug prices via rebates to drug manufacturers. At a Congressional hearing in Oct. 2017, after many visits from rheumatologists and members of ATAP, the members of the Senate Committee on Health, Education, Labor, and Pensions “held the feet of these PBMs to the fire a little bit asking them about these rebates,” Dr. Worthing said, where at one point committee chair Sen. Lamar Alexander (R-Tenn.) asked, “ ‘Do we really need these rebates?’ ”

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