In Advocacy, Slow and Steady Wins the Race

Earlier in the year, it seemed that healthcare reform was stopped in its tracks because of the Massachusetts Senate special election—which placed Republican Scott Brown in the seat held by the “Liberal Lion,” Edward M. Kennedy. The Senate Democrats lost their supermajority and the momentum to pass President Obama’s healthcare reform legislation subsided. But through strong lobbying by the president, Speaker Nancy Pelosi (D-Calif.), and Senate Majority Leader Harry Reid (D-Nev.), Congress passed the Patient Protection and Affordable Care Act (H.R. 3590)—comprehensive healthcare reform—on March 21, and the president signed the bill into law on March 23.

A number of factors almost blocked the passage of healthcare reform. During this process we learned that passing legislation—and developing policies that benefit patients, support physicians and health professionals, advance health research, and improve the U.S. healthcare system—is a very difficult task. Filibusters, party politics, closed-door negotiations, congressional rules, parliamentary procedure, and strong political ideologies all affect legislation and health policies moving through Congress.

Although creating beneficial health policies is not an easy battle, it is still worth the fight. Thus, the ACR continues to educate lawmakers and urge support of issues directly affecting rheumatology professionals and patients living with arthritis, rheumatic, and musculoskeletal diseases by going to Capitol Hill and speaking to Congress.

Speaking for Rheumatology on Capitol Hill

Over the years, the ACR has made an impact in Washington. ACR and ARHP members have formed solid relationships with congressional members and their staffs. Offices recognize the ACR logo, and staff desktops include the ACR’s leave-behind item—a bone-shaped stress-reliever—a reminder of meeting people who passionately conveyed personal stories. Some of the stories told on Capitol Hill over the years include those of a young girl with juvenile rheumatoid arthritis who cannot participate in recess or walk up the stairs for her fifth-grade class and a 9/11 firefighter with scleroderma. These patients are living proof of the importance of rheumatology and are not easily forgotten.

Each spring, the ACR goes to Capitol Hill for Advocates for Arthritis to educate Congress on hot issues affecting the rheumatology community. This year, the Advocates for Arthritis fly-in was held March 15–16. During the event, more than 120 rheumatologists, rheumatology health professionals, and patient advocates walked the halls of Congress to lobby legislators on important issues affecting the rheumatology community.

Advocates spoke to Congress about a number of issues, including:

• A permanent repeal to the sustainable growth rate;
• The negative effects of the elimination of consultation codes;
• Legislation to ensure access to osteoporosis testing;
• The creation of a pediatric subspecialty loan repayment program;
• The Arthritis Prevention, Control, and Cure Act; and
• A continued increase for arthritis research funding.

Next month, the ACR board of directors will go to Capitol Hill to reiterate the importance of these issues and expand our network of congressional supporters. As leaders of the ACR, board members dedicate time to ensure that members of Congress are reminded of the issues important to the rheumatology community.

Small Steps Toward Big Legislation

In the 110th Congress, the Arthritis Prevention, Control, and Cure Act (H.R. 1283/S. 626)—a priority of the ACR—passed the U.S. House of Representatives. After four years of educating Congress, urging co-sponsorship, and meeting with House and Senate leadership, Representatives Anna Eshoo (D-Calf.) and Chip Pickering (R-Miss.) ushered the bill through the House only for it to be stopped in the Senate due to the congressional calendar—namely, the 2008 elections—and Senate rules.

In 2009 (and with the start of the 111th Congress), the ACR returned to Capitol Hill and again encouraged co-sponsorship of the Arthritis Act (H.R. 1210/S.983). ACR staff and volunteers met with congressional leadership to finally pass this important legislation. Unfortunately, healthcare reform took precedence over all health bills in 2009, leading to another speed bump.

Although the Arthritis Act was put on the back burner while healthcare reform dominated the first session of the 111th Congress, it is still acquiring co-sponsors and remains a priority of the ACR. We continue to work with the Pediatric Workforce Work Group—a coalition of pediatric medical subspecialty, pediatric surgical specialty, and related organizations formed to address a shared concern over the critical shortage of specialists available to care for children—on creating a pediatric loan repayment program for all pediatric subspecialties. Although the Arthritis Act includes a provision to create a loan repayment program specific to pediatric rheumatology, the College’s work with the coalition has already led to the introduction of the Pediatric Workforce Investment Act (S. 1206/ H.R. 4273) by Sen. Sherrod Brown (D-Ohio) and Rep. Carolyn Kilpatrick (D-Mich.). This bill was included as a provision in the Patient Protection and Affordable Care Act, the comprehensive healthcare reform legislation.

Like the Arthritis Act, another priority piece of legislation to the ACR addresses the devastating cuts to duel-energy X-ray absorptiometry (DXA). A provision was included in the Patient Protection and Affordable Care Act that returns reimbursement for DXA screenings to 70% of the 2006 levels (approximately $98) for two years while the Institute of Medicine performs a study on the ramifications of payment reductions. This is another victory for years of advocacy.

Although the 70% provision might not feel like a complete victory, it is important to note that on Capitol Hill, money dictates most policy decisions, and returning reimbursement to 100% of the 2006 levels would be too costly. However, as we continue to educate Congress on the importance of DXA screenings as a preventive measure in early detection and treatment of osteoporosis, we can work toward fair reimbursement and ensure patient access to care.

The ACR continues to work with the DXA Sister Societies to encourage a congressional fix to the severe cuts to DXA reimbursement. Ensuring access to DXA screenings would serve as a preventative measure and could save millions of dollars and millions of lives.

Point Taken—The Legislative Process is Slow. What Can I Do?

Moving legislation through Congress takes time, but we must continue the fight. If you are sitting still, the reality is that you are actually moving backwards.

Many rheumatologists and rheumatology health professionals feel it important to go to Capitol Hill to meet with their lawmakers. Many find the process exciting and something that gives them a feeling of working toward an important goal.

However, you don’t have to go to Washington to make an impact with your legislators. There are a number of ways for you to be an ACR advocate.

• Respond to ACR e-mail alerts on needed advocacy actions;
• Contact your U.S. representative and senators (via e-mail, fax, or phone) and educate them on issues affecting the rheumatology;
• Visit your legislators or their district staff at home;
• Attend a town hall meeting;
• Invite your U.S. representative or senator to visit your office;
• Urge other rheumatology professionals and patients to advocate; and
• Learn about RheumPAC by visiting www.rheumatology.org/advocacy today.

Policy making is a slow process across the board—not just on the issues important to the rheumatology community. However, members of Congress listen to you because you are their constituents, and they have been elected to represent your needs in Washington. The ACR’s collective advocacy efforts—educating through communications (e.g., letters, e-mails, and phone calls), in-person visits, presence at town hall meetings, and RheumPAC support—will continue to enhance our presence on Capitol Hill and eventually produce positive health policy for ACR members and your patients.

ACR staff members are available to help you prepare to speak with your members of Congress and can provide information on organizing an office visit, what to expect at a town hall meeting, and specific policy issues. For questions about advocacy, or to start your efforts, e-mail [email protected].