The American College of Rheumatology (ACR) has become one of the latest healthcare advocacy groups to publicly lobby Congress, as the GOP leadership continues efforts to repeal the Affordable Care Act (ACA), more commonly known as “Obamacare.” In a letter addressed to both House and Senate leadership, the ACR recommended that any changes to the health care law retain the current provision that prohibits insurers from denying coverage to those with pre-existing conditions.1 

“We urge leaders to ensure that proposals will protect and promote access to adequate and affordable health insurance for all citizens,” wrote Sharad Lakhanpal, MBBS, MD, president of the ACR. “In particular, the ACR recommends that all Americans should be covered by continuous health insurance that encourages high quality health care,” he added. 

However, unlike the American College of Physicians, which last week explicitly said in a letter that it does not support a repeal of the ACA, the ACR declined such a declaration and instead provided a list of specific provisions it advocates as the Republican-controlled Congress considers replacing Obamacare with its own version of healthcare reform.


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The reforms the ACR recommends as part of any new legislative proposal include: 

  • Repealing the Independent Payment Advisory Board (IPAB) provision of the ACA
  • Establishing universal prior authorization systems for multistate insurance plans
  • Help combat the high cost of biologic arthritis drugs by maintaining the ability of the US Food and Drug Administration to approve “safe and effective biosimilars” that will encourage market-based competition 

The IPAB established by the ACA was tasked with achieving cost savings for the Medicare program and shifted authority to make changes to Medicare from Congress to the IPAB. This is an inappropriate way to curtail healthcare spending, according to Angus Worthing, MD, FACP, chair of the ACR’s Government Affairs Committee.

“The risk of harm is too great when responsibility for Medicare decisions is mired in additional levels of bureaucracy, particularly one that is immune from congressional oversight and not accountable to all stakeholders,” he told Rheumatology Advisor

Dr Worthing added that he agrees with previous statements from the American Medical Association that criticized the IPAB for its ability to impose near-unfettered cuts in physician payments that can negatively affect access to health care for Medicare patients. 

“Rheumatology is predominantly a cognitive specialty; doctors provide value by figuring out what kind of arthritic or rheumatic condition ails our patients and which treatment would be best for each individual,” Dr Worthing continued. He explained that the type of “cognitive office-based services” provided by rheumatologists can improve the quality of life for patients but are also at greater risk for cuts by the IPAB. 

“Cutting these kinds of services could make it harder for people with arthritis to find the right care and treatment they need,” he warned. “Instead of giving this kind of cost-cutting mandate to an unelected government panel, health reforms should be deliberated by elected officials accountable to voters who face the complexities of rheumatologic diseases.” 

As for the ACR’s letter to Congress, in his parting comments, Dr Lakhanpal also appealed to the fiscal concerns of congressional leaders by highlighting the value of widely available preventive care. “We serve patients with serious conditions that can be difficult to diagnose and treat,” noted the ACR president. “Early and appropriate treatment of these especially vulnerable patients by rheumatologists can prevent or slow disease progression and decrease the likelihood of long-term disability and the costs associated with it.”

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References

  1. ACR urges priorities ahead of healthcare reform debate. Atlanta, GA: American College of Rheumatology. Published online January 18, 2017. Accessed January 18, 2017. 
  2. American College of Physicians lobbies Congress to spare Obamacare. Rheumatology Advisor. Published online January 11, 2017. Accessed January 18, 2017. 

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