The ACR, ARHP Keep Members, Patients’ Priorities on Congressional Legislative Slate

We can’t change the direction of the wind, but we can adjust our sails.

barkarola/shutterstock.com

The origin of this proverb is unclear. Some citations link it to ancient Hindu philosophers, and others suggest the origin may be closer to home (i.e., Jimmy Dean or Dolly Parton). Nonetheless, the sentiment is apt: We are living in an almost-unprecedented time in which troubling policies emerge in an unrelenting succession. Like a series of tropical storms, such policies threaten our workforce, patient access to healthcare and the rheumatology research central to the breakthroughs our patients envision.

The ACR, and by extension the ARHP, has earned the reputation on the Hill of being a politically active, but reliably nonpartisan organization. Over the years, we have forged strong relationships with congressional representatives on both sides of the aisle. These relationships have enabled the ACR to successfully advocate for our members and their patients. Volunteers serving on various committees, including the Committee on Government Affairs, RheumPAC, the Affiliate Society Council, the Committee on Rheumatologic Care, the Board of Directors and the Executive Committees, have successfully lobbied for numerous causes that advance rheumatology practice and research.

The ACR has a time-tested process with checks and balances to develop positions on pertinent issues that help guide its advocacy and other efforts. The Board of Directors is the governing body of the ACR. The position statements for the ACR are developed by the relevant committees and brought to the Board for discussion and vote for approval. Once approved by the Board, these become the policies of the ACR that govern its business and are carried out by its volunteers and staff.

Although there have been challenges along the way, the wind, for the most part, had been at our back. The direction of political winds in our country has changed recently. In January, a new administration took office, and the political climate shifted appreciably. There is concern about how our patients’ healthcare and access to it will be affected, the potential impact on the practice of medicine, and the future of federally funded rheumatology research and training. All are critical issues for the ACR.

Travel Bans & H-1B Visas

Dr. Lakhanpal & Dr. Hassett

On Jan. 27, the White House issued an Executive Order that broadly suspended travel from certain foreign countries into the U.S. Such a travel ban could have a negative impact on patient care, medical research, education and international collaboration. The ACR/ARHP issued a statement emphasizing our support for the open interchange among individuals from around the world with regard to research, training, education and the provision of healthcare. Further, along with 36 other medical organizations, the ACR was a signatory on a letter developed by the Council of Medical Specialty Societies (CMSS) to express our opposition to the travel restrictions.

More recently, the ACR has written to the president and the director of Homeland Security to request that medical professionals be exempted from the suspension and any future modifications of the H-1B visa program to allow for international physicians to continue to enter the U.S. to take care of our underserved patients. Lastly, and perhaps most importantly, we have been communicating with our international colleagues to express our concerns with regard to travel restrictions, as well as our respect and regard for their expertise and friendship. The full impact of the Executive Order on travel restrictions may not be realized until we meet for the ACR/ARHP Annual Meeting in San Diego later this year.

ACA Repeal & the AHCA

The next shift in the wind carried with it the threat of the loss of access to healthcare for millions of Americans. In response to the proposed legislation to repeal and replace the Affordable Care Act (ACA), we wrote a letter to Speaker Ryan, Majority Leader McConnell, Minority Leader Pelosi and Minority Leader Schumer on behalf of our membership. The letter stated, in part, that “all Americans should be covered by sufficient, affordable and continuous health insurance that encourages high quality healthcare. Such high-quality healthcare would include treatment for arthritis and rheumatologic diseases with access to a rheumatologist and other rheumatology health professionals for both consultative and maintenance care.”

Since the passage of the American Health Care Act (AHCA) of 2017 by the House, the ACR has written to leaders of the U.S. Senate, stating that revisions to the AHCA should include:

• No preexisting illness exclusions;
• Affordable premiums, deductibles and cost sharing; high-deductible plans can reduce access to medically necessary rheumatologic treatments, such as biologics;
• Limitation of patient copayments, which reduce access to care and treatments;
• Caps on annual out-of-pocket patient costs and a ban on lifetime limits on healthcare benefits;
• Coverage allowing children to remain on their parent’s insurance plan until age 26;
• Coverage for services that are exceptionally valuable to arthritis patients (e.g., biological therapies, physical and occupational therapy);
• Coverage of health educational activities for chronic arthritis patients, realizing the importance of education in the management of chronic rheumatic diseases;
• Recognition of the difficulties of travel for rheumatic disease patients: laboratory, radiological services and infusion services should be conveniently available near the source of the patient’s medical care; and
• Continuation of the currently required essential health benefits, in order to ensure patients have access to a robust set of healthcare services.

Our objective over the last several months has been to be responsive in a timely and nonpartisan manner. This requires being agile, engaged, focused and politically neutral to best serve the needs of our members and their patients. The strategy seems to be working and once again getting the wind at our backs. Many of the editorials and other articles recently written by the College supporting the advance of rheumatology and the care of our patients have caught the attention of and been published in prominent and pertinent Washington, D.C., and other health policy publications.

RheumPAC

Angus B. Worthing, MD, FACP, FACR, chair of the Committee on Government Affairs, and the ACR staff have done a remarkable job of staying on top of political developments in D.C. and helping respond in a most expeditious manner. Going forward, advocacy will be more important than ever. We encourage you to kindly invest generously in RheumPAC and share your thoughts with its chair, Harry Gewanter, MD, FAAP, FACR. Please express your support and appreciation for our volunteers serving on the Committee on Government Affairs and RheumPAC. Their efforts will be instrumental in securing the relationships that will help us navigate the ever-shifting winds in these challenging times.

To best serve our membership, and by extension our patients, it might be wise to follow an old proverb from India: “If you live on the river, befriend the crocodile.”

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).

Afton L. Hassett, PsyD, is president of the ARHP, a clinical psychologist and an associate research scientist in the Department of Anesthesiology at the University of Michigan.