Other current legislation supported by the ACR and aimed at improving access to medical care includes:
- H.R. 2141/S. 898, the Conrad State 30 and Physician Reauthorization Act, which streamlines the J-1 visa program for foreign physicians to practice in underserved areas;
- H.R. 2266, the Resident Physician Shortage Reduction Act of 2017, which would create additional residency positions; and
- S. 989, the Ensuring Children’s Access to Specialty Care Act of 2017, which would make pediatric rheumatologists eligible for the National Health Service Corps’ loan repayment program.
NIH research funding
The ACR and its coalition partners were able to persuade Congress not to decrease the government’s commitment to medical research funding through the National Institutes of Health (NIH); the Trump administration had proposed a 22% decrease. The ACR hand-delivered more than 100 letters to members of Congress, and advocates met with key members of Congressional committees, including Rep. Tom Cole (R-Okla.) and Sen. Roy Blunt (R-Mo.). The committees voted instead to increase the NIH budget for the coming fiscal year (the Senate voted for a $2 billion increase, and the House voted for a $1.1 billion increase). Although at press time a final omnibus appropriations bill had not yet been enacted, drastic cuts in the NIH budget now appear unlikely.
This development is critical for the rheumatology community, some of whose members are engaged in discovering new therapies, Dr. Worthing said. In addition to the NIH budget, the ACR continues to advocate for funding the Centers for Disease Control and Prevention’s Arthritis Program, and the development of a new, $20 million dedicated arthritis research program in the Department of Defense (DoD). The ACR’s advocacy efforts have included raising Congress’s awareness of the impact arthritis has on the armed services and the importance of pursuing arthritis research through the DoD. Arthritis is the second-leading cause of medical discharge from the Army and the leading cause of disability among veterans.
The Independent Payment Advisory Board
The Independent Payment Advisory Board (IPAB), a government agency created by the ACA to push cuts in the Medicare system when spending targets are not met, was targeted for repeal by the ACR and other medical groups. A vote to repeal IPAB was passed by the House on Nov. 1, and companion efforts in the Senate had 49 cosponsors.
Cap on rehab therapy
Originally created as a healthcare cost-cutting measure in 1997, an arbitrary cap on rehabilitation therapy expenditures under Medicare during a calendar year sometimes has the effect of precluding coverage for physical, occupational and speech language therapies needed by rheumatology patients. Bills that would eliminate the cap on rehab therapies have been introduced in Congress for the past four years, and the cap is now closer than ever to being repealed. A bipartisan framework has been adopted by key committees in the House and Senate, and Dr. Worthing says, “Congressional leaders have joined together to reopen Medicare access to rehabilitation therapies.” The respective bill numbers for the Medicare Access to Rehabilitation Services Act of 2017 are H.R. 807 and S. 253.
