Editor’s note: This blog by Dr. Worthing originally appeared on the ACR’s Advocacy Listserv.
Here’s a perspective on the current climate in which your government affairs team works. As you read this list of observations, imagine you’re a lawmaker and try to find where the ACR’s agenda fits into the current landscape:
- Washington is highly politicized. Interparty rancor grew with the highly politicized SCOTUS [Supreme Court of the United States] confirmation and removal of the filibuster by Republicans. Also, intraparty conflict within the Republican party was stoked when moderates and Freedom Caucus members did not support the Ryan/Trump healthcare bill. (As you probably know, the bill failed; now, it’s a zombie—neither dead nor alive; more below.)
- Institutions are weakening. Multiple global and domestic institutions are losing support, recognition, power or relevance. Take your pick: NATO, the Senate, SCOTUS, U.S. federal agencies, election campaigns. Leaders on both sides of the aisle are concerned about this.
- People are being investigated. The Senate and FBI are investigating Russia and the Trump 2016 campaign regarding the presidential election. This creates work for all sides, possibly limiting the focus on other legislative and executive initiatives, possibly influencing Trump’s behavior and testing alliances in the balance of power with third parties (e.g., ISIS, Syria, Iran, Turkey).
- Have you noticed any relevance to rheumatology yet? Moving on: the U.S. bombed Syria after Syrians were gassed in the ongoing war there. Civil war? Proxy war? Secretary of State Tillerson is in Russia asking [Russia] to stop supporting Syria’s dictator (see #3 above). He could use the support of NATO (see #2).
- There isn’t a clear overarching White House agenda. After a flurry of executive orders and a failure to pass the healthcare bill, priorities are unclear. And with infighting between senior White House staff, there are no high-level interlocutors to convey policy.
- U.S. government funding ends April 28. This will probably force some bipartisanship to renew a continuing resolution (CR) and/or a budget, while other activity stalls. The $17 trillion debt and White House proposals to raise military spending may pressure leaders to reduce domestic discretionary spending (research) and entitlement programs (healthcare). Aha! There’s the beginning of the ACR agenda.
My apologies if the point is heavy handed, but long story short, we rheumatology advocates can be forgiven for feeling like we’re a little low on the priority list nowadays. But rest assured, your team is hard at work. Also, lawmakers are continually campaigning and want to start a relationship with us. The relationships we’ve nurtured through RheumPAC and our commonsense and nonpartisan initiatives have never been more critical.
Here is a review of what your government affairs team is hearing, and what we are telling our friends on the Hill and in federal agencies.
The Zombie Healthcare Bill
As you know, it failed to pass. The ACR and many other organizations weighed in against provisions that risked dropping insureds. The bill may be retooled. Meanwhile, the Trump administration may change the way it regulates Obamacare subsidies, mandates and other rules. On the positive side, the HHS stated that the Trump administration will continue to pay subsidies to insurance companies as the Obama administration did, despite Republican lawsuit against the payments. This would help keep insurance markets stable. Unfortunately, two days after that statement, the White House walked it back. As the debate continues, the ACR is ready to advocate for access to care and treatments with the Congressional committees and administration regulators.
Immigration & Visas
Remember the immigration ban? The judicial branch stopped it. Look for the Supreme Court to take up the case this summer.
Meanwhile, a separate immigration issue popped up. Last week, the Department of Homeland Security reduced the ability of international medical graduates (IMGs) to obtain H-1B visas this year. This is the visa that foreign doctors typically use to stay in the U.S. and work in underserved areas after completion of their residency and/or fellowship. Typically, potential employers of IMGs can pay to have the IMG’s visa processed quickly (yielding a yay or nay). Last week this priority processing was suspended for up to six months. It appears to be a move by President Trump to reevaluate the influx of predominantly IT workers, and doctors are caught in the crossfire. The ACR will be asking the administration to exempt doctors from this action. The ACR issued a statement the week of April 9 about this, while also praising Senators Klobuchar, Heitkamp and Collins for introducing a bill to allow foreign doctors to continue working after their residency in underserved areas.
In advance of the ACR/ARHP Annual Meeting in San Diego later this year, the ACR has created a section on its website to welcome international attendees in the spirit of global scientific collaboration and provide information on visa and travel.
The ACR’s Approach to Lowering Drug Prices: Biosimilars & Transparency
The ACR has developed a two-pronged approach to help lower the prices of the absurdly expensive drugs we prescribe. There is good news in each:
Prong 1: Support safe, effective biosimilars to compete with reference biologics. For the prices of biologics to drop, biosimilars must be approved, and for that to happen the FDA needs stable funding and innovative ways to hire approval experts quickly. Enter Scott Gottlieb, MD, who was just confirmed as the FDA commissioner. He is on record as wanting to speed up drug approvals. As long as the FDA continues to prioritize safety and efficacy, this may bode well for reducing biologics prices.
Prong 2: Increase transparency of the pricing schemes between pharmacy benefit managers (PBMs), manufacturers and insurers. The ACR is teaming up with CSRO and other organizations in a coalition to expose the secrecy and conflicts of interest in the PBM pricing system. This is gaining bipartisan traction on the Hill as lawmakers are becoming interested in transparency for patients and employers whose insurance premiums are increasing.
There is some room for optimism in our two-pronged approach to lowering drug prices via biosimilars and drug price transparency. The ACR recently praised lawmakers for creating momentum on our issues.
May Hill Visit
Next month, ACR leaders will be on the Hill advocating to advance multiple issues. We will press for increased NIH research funding and also for creation of a new arthritis research program to be housed at the Department of Defense. Sen. Alexander (R-TN), powerful chair of the Senate’s committee on health, says Congress would raise, not lower NIH research funding despite President Trump’s suggested cuts. We will also support ways to improve the projected rheumatology workforce shortage, including the H-1B visa issue above, as well as increasing GME slots and funding. Finally, we will ask Congress to repeal IPAB—the unelected group of officials who could have power to cut physician reimbursement without full Congressional oversight.
Good News from the Local D.C. City Council
Your ACR state advocacy team shepherded a copay cap through the D.C. City Council last year. Then, as per the Constitution, Congress reviewed our bill—and thankfully, it was cleared Apr. 14. Now, D.C. becomes the third state or territory to limit specialty drug copayments to $150 a month. No more thousand-dollar coinsurances.
I encourage you to get involved in your state rheumatology society and share your views with your legislators. You, too, can make a law. For example, 26 states have biosimilar bills on the books—mainly to ensure that prescribers would be informed of a substitution —and you can easily get involved in this and other important initiatives at the ACR.
Angus’s To-Do List
Keep Rheumatology Strong and join the AMA. You can win free hotel or registration for ACR San Diego! We still need roughly 200 more ACR members to join the AMA this year in order to keep our AMA delegate and leverage our initiatives with the house of medicine. Call 800-621-8335 or sign up online, and forward this bulletin to your ACR friends.
- Download the Voter Voice app on your Android or iPhone. It offers a quick way to write letters to your members of Congress about ACR initiatives.
- Go here to tell your Member of Congress to create a rheumatology research fund at the DoD. It takes less than a minute!
- Invest in RheumPAC.
Angus B. Worthing, MD, FACP, FACR, is a practicing rheumatologist at Arthritis & Rheumatism Associates PC in Washington, D.C., and the chair of the ACR’s Government Affairs Committee.