The Health Care Bill, Trump’s “Skinny Budget” & Much More!

Dr. Angus WorthingAngus B. Worthing, MD, FACP, FACR

Greetings from Washington DC! The advocacy team for the American College of Rheumatology (ACR) had another busy month and I am honored to be the lead rheumatologist on that team. In order to keep our focus on health policy, I’ll avoid mentioning anything about Washington investigations into obstruction of justice, collusion, etc. You get enough of that elsewhere!

The Health Care Bill

Obamacare repeal and reform efforts are speeding up and becoming more secretive. As many of you know, the house passed a bill repealing and replacing components of Obamacare (see my #simplestasks update here). The Senate isn’t holding public hearings on their version of the health care bill, but rather writing a bill in secret, as the NYT reports. ACR notified Senate leadership through letters and over a hundred in-person meetings last month about how best to protect the interests of our patients and the profession. We’re currently following up on those contacts. From what we have heard and seen in the media, Senate leadership is negotiating within the Republican caucus about covering pre-existing conditions and winding down the Medicaid expansion, and hopes to vote on a bill before the July 4th recess. Meanwhile everyone reading this can easily send a pre-written, editable letter to their Senators by going to this link and clicking on taking action. Just takes a minute and now’s the perfect time. Your leaders need to hear your voice!

Trump’s “Skinny Budget” for FY18

ACR joined with many health advocates in opposing the Trump administration’s proposals for sweeping cuts to NIH, Medicaid, CHIP, and taxpayer funding of FDA. Of note, budget proposals are only that – proposals – and Congress ultimately decides the federal budget. Thankfully, many members of Congress oppose Trump’s cuts. But Trump has created a tone of spending cuts. Meanwhile, ACR did endorse two rheumatology-friendly parts of the budget which would boost funding for graduate medical education to train more rheumatologists, and repeal the Medicare-cutting mechanism known as IPAB. As Congress begins the budget process, ACR’s advocacy team has also established strong support for a new, dedicated arthritis funding stream through the Dept of Defense. Take 1 minute to send an email telling your member of Congress to repeal IPAB and support arthritis research (go here and click on 7 advocacy campaigns, or just google rheumatology legislative action center).

ACR helping reduce administrative burdens:

ACR recently met with leaders at Health and Human Services and also sent a letter to Center for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting regulatory relief to reduce administrative burdens that can distract doctors from taking care of patients. We advocated for modifying Medicare’s billing codes to reflect the value of rheumatology care, improving transparency in the way CMS makes rules, and making both tracks of the new Medicare payment system or “MACRA” more feasible for rheumatologists. Read the letter here. Speaking of MACRA: if you are aware of the possible reimbursement cuts to Medicare providers coming through the modifications to the fee-for-service system, you may be interested in how a rheumatology-related Alternative Payment Model (APM) might allow rheumatologists to avoid them. For several months, a team of ACR volunteers has been designing an APM for this purpose. The purpose of this kind of model would be to let rheumatologists focus on taking care of patients in a patient-centered way instead of worrying about billing and red tape. The team is focusing on rheumatoid arthritis, but the experience may lead to innovative care systems for other disease states. Stay tuned!


Many of you may be familiar with biosimilars, which are generic-like versions of complex biologic drugs that became available in the US this year. ACR commented on the FDA’s proposed pathway to approve biosimilars as “interchangeable” (i.e., able to be substituted by a pharmacist for the reference or “brand” biologic) in late May. The ACR advocacy team strongly supports FDA’s proposal for very robust clinical trials that would switch patients between reference drug and biosimilar at least 3 times (A-B-A-B) in order to prove safety and efficacy prior to FDA approval. The ACR also asked FDA to use drug names that include meaningful suffixes (instead of the random suffixes currently in use) that would make biosimilar names more memorable and easier to work with for doctors and patients. My recent op-ed details some of the current issues and salient points about interchangeability.


As we learn of the scientific findings coming out of the European rheumatology conference this week, it’s a reminder that the ACR’s Annual Meeting is just around the corner. Unfortunately, due to the new “extreme vetting” of visitors to the US, ACR, like other organizations, is anticipating a possible drop in international attendees at the meeting this November. The ACR has a website for international travelers. If you happen to know someone traveling from abroad, point them to this website.

Coalition to take on PBMs

ACR joined a coalition dedicated to transparency for pharmacy benefits managers, called the Alliance for Transparent & Affordable Prescriptions. Congress is holding hearings on PBMs and the drug pricing system as the major industry stakeholders start pointing fingers at each other to spread the blame about high drug prices. Recently, coverage has increased in the press and medical literature (apologies for the paywalls): JAMA, NY Times, WSJ and WaPo.

MedPAC deja-vous

MedPAC, the independent US federal policy commission, is at it again. They proposed to reduce reimbursement for medications given through the Medicare Part B program– such as biologics given in doctors offices — and to allow companies to create prior authorization programs, step therapy, and other barriers to Medicare treatments. The ACR and many state rheumatology societies sent a letter to HHS Secretary Price urging him not to adopt the recommendations. The ACR’s advocacy team is watching this closely and will respond forcefully — with the help of other physician and patient advocacy groups — if CMS begins to adopt any of these plans.

Thanks for reading! Don’t forget to make your voice heard on Capitol Hill!

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