As the 115th Congress and the Trump administration consider potential reforms to the healthcare system, including actions related to the Affordable Care Act (ACA), physicians around the country remain vitally concerned about the need to preserve and improve access to care for their patients.
To that end, the ACR continues to lobby for policies that will ensure access to quality healthcare and ensure the cost of care is not a barrier to access. In a letter sent to Congressional leaders, the ACR requested specific healthcare provisions to ensure access to care:
- 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 costs;
- 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;
- Continuation of the currently-required essential health benefits, in order to ensure patients have access to a robust set of healthcare services; and
- Maintain the Food and Drug Administration’s authority to approve safe, effective biosimilars.
The ACR’s position statement on access to care encapsulates these points, and advocates for adults and children to have access to continuous health insurance to ensure high-quality healthcare coverage for conditions specific to rheumatology, including chronic arthritis and rheumatic diseases.
Patient Benefits
The need for high-quality healthcare coverage for these patients is underscored by the substantial benefits of access to care that, for example, can reduce morbidity and prevent disability in patients when rheumatoid arthritis is detected early and treated adequately. Patients with rheumatic conditions who have proper access to expensive medicines, such as biologics, as well as access to rheumatologists, who are in short supply, have significantly improved outcomes.
Other Key Areas of Advocacy
In addition to advocating for the preservation of select features of the ACA and addressing cost concerns, the ACR position statement also advocates for the expansion of provider networks to ensure access to expert rheumatologic care, according to Colin C. Edgerton, MD, a member of the ACR Committee on Rheumatologic Care.
The ACR’s position statement also supports improving access to both initial and consultative rheumatologic services and ongoing care. For example, the ACR advocates for healthcare policies that permit rheumatologists to operate medical practices across a plurality of settings, including geographic (rural and urban), size (small and large), and type of practice (solo practices, multispecialty groups, academic centers and those affiliated with other health systems).
Another key area of advocacy noted in the position statement: ensuring that patients have access to medications and other medically necessary treatments, which includes ensuring that the FDA maintains its authority to expedite the approval of safe and effective biosimilar agents. The ACR further advocates for the elimination of certain practices, such as prior authorizations, to simplify the delivery of high-cost treatments. The ACR supports minimizing administrative burden through universal prior authorization systems in the case of multistate insurance plans, and other actions to remove excessive administrative burdens that prevent physicians from focusing on patient care.
Get Involved
Along with advocating directly at both the state and federal levels, the ACR partners with other physician specialty societies, as well as the American Medical Association through its House of Delegates, to build effective coalitions to strengthen its advocacy for access, says Dr. Edgerton. He emphasizes the need for rheumatologists to get involved individually. “Member participation in RheumPAC and individual rheumatologists’ membership in the AMA are critical to allow the ACR to ‘punch above its weight’ when advocating for access to rheumatologic care,” he says.
Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.
Resource
1. American College of Rheumatology. Position Statement. Access to Care.
