The Latest Plan To Repeal and Replace The Affordable Care Act Ends?

Dr. Angus Worthing

Dr. Angus Worthing

Angus B. Worthing, MD, FACP, FACR

Greetings from Washington, DC! It’s been a busy summer for health policy advocates. On September 26, the latest plan to repeal and replace the Affordable Care Act endedfor now. There’s a chance it that debate may resurface, or it could shift to a bipartisan plan to stabilize the insurance marketplace. For those who might be interested in sending a message to their member of Congress about rheumatology-related issues, you can find prewritten emails on today’s hottest advocacy topics and send an email to your “MOC” today at the American College of Rheumatology’s website for patients and families, Simple Tasks. Tell Congress your thoughts about healthcare reform, a national copayment cap for specialty drugs, ending the annual caps for patients getting physical therapy in Medicare, and the negative effects of pharmacy benefit managers (PBMs) on the drug pricing system (see below for more). I encourage you to exercise your First Amendment rights and speak up now!

Advocates for Arthritis

The American College of Rheumatology’s Government Affairs Committee, which I am honored to chair, along with other volunteer rheumatologists and rheumatology health professionals, and many of our patients, have been busy recently with advocacy. This week, we gathered in Washington, D.C. at the ACR’s annual visit to Capitol Hill, Advocates for Arthritis. We held over 100 in-person meetings with members of Congress and their staff about the most pressing current federal issues. The committee chose four major topics: capping specialty drug copayments, ending the annual cap on Medicare rehab/physical therapy services, educating Congress about the pitfalls of PBMs that drive up drug prices, and thanking Congress for plans to boost NIH research.  In one of these meetings, Senator Murkowski (R-AK) was given the ACR’s Award for Public Leadership in Rheumatology, presented by our own Dr. Sarah Doaty of Alaska, for her efforts in reducing the workforce shortage in her state and maintaining access to care during the healthcare reform debate (see photo). In another meeting, the ACR Executive Committee thanked Senator Collins (R-ME) (see photo) for helping maintain access to care for people across the U.S., hours after she courageously spoke out for the same principles the ACR Board of Directors ratified earlier this year about health reform.

Even though the Hill visit has ended physically, like I said, you can still participate in the ACR’s Hill visit virtually by going to the Simple Tasks website to email your member of Congress to magnify our voice. You can also review the ACR statement on the College’s strong concerns that the Graham-Cassidy plan did not go far enough to protect people with arthritis and rheumatologic diseases.

Research Boost

The Senate health committee has budgeted a $2 billion increase in biomedical research funding for 2018. This nearly doubles the $1.1 billion increase from the House committee. The ACR thanked Congress in over a hundred personally delivered letters at our recent Hill visit. If the budget is successfully passed, it will represent a stark contrast to the 22% reduction in NIH research that the Trump administration proposed.


The ACR and ATAP have been active in exposing the problems with pharmacy benefits managers, by educating members of Congress, and meeting with administration officials at the Office of Management and Budget. On August 6, a Wall Street Journal exposé reported that PBMs get an even larger cut of drug bills than actual pharmacies ($18 from a theoretical prescription that costs $300), and as we know, even though this money is often called a “rebate,” it goes to PBM profits and not back to patients. Rebates can also incentivize drug companies to increase, rather than decrease, their drug prices. The top three PBM companies are all in the top 25 on the Fortune 500 list. Follow the story at and consider going to the website to tell your stories of frustration with PBMs.

Cutting “Red Tape”

On an optimistic note for rheumatologists, both the Centers for Medicare and Medicaid Services and Congress recently requested suggestions from physician groups about how to cut bureaucratic red tape. The ACR advocacy team submitted our ideas to Congress recently, and on September 27, the ACR Executive Committee followed up on those comments through in-person meetings – specifically, asking Congress’s health committees to help us avoid a potentially disastrous Medicare penalty that would adjust reimbursements on in-office drug costs; to reduce the burdens of prior authorization in Medicare Advantage plans for doctors and patients, and to direct Medicare to study ways to better value cognitive services like rheumatology, to help reduce our coming workforce shortage and wait times to see a rheumatologist. I’ll keep you posted on our progress.

Thanks for taking the time to read this and please consider getting involved in advocacy

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