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ACR Says Senate Healthcare Bill Falls Short of Protecting Americans with Rheumatic Disease

Dr. Sharad Lakhanpal, President of the American College of Rheumatology (ACR) has responded to the Senate's proposed changes to healthcare coverage in the USA.

“The American College of Rheumatology has always stood for affordable and accessible healthcare coverage for the 54 million Americans living with rheumatic diseases. We are concerned the discussion draft of the Better Care Reconciliation Act introduced by Senate leadership this morning falls short of that goal, and we stand ready to work with the Senate leadership to address these concerns.

“Amid the ongoing debate in Congress concerning the future of the Affordable Care Act (ACA), the ACR has been clear about the provisions that would need to be included in a replacement bill to ensure Americans continue to have access to comprehensive and affordable rheumatologic care. Among them: protections for Americans with pre-existing conditions, coverage of essential health benefits for services particularly valuable to arthritis patients, and affordable premiums with low deductibles and minimal cost sharing. Though there are elements in the Senate bill that we find promising, the ACR still believes that it does not go far enough in ensuring these protections.”

“We support the Senate bill’s prohibition on states opting out of the ACA’s community rating requirements, however the bill still allows states to waive the law’s essential health benefits and many of its consumer protections. If these provisions are waived, healthcare coverage could become unaffordable for those with pre-existing conditions, including arthritis. We propose that moving forward, the Senate should include a special exception from state essential health benefit waivers to protect individuals with chronic conditions from price discrimination.”

“While we are pleased to see that the Senate bill includes tax credits based on age rather than income, as was the case with the House version, the ACR believes that these do not go far enough in ensuring individuals living with rheumatic disease will be able to maintain their current level of coverage. While tying tax credits to age would make it easier for older Americans to qualify, the bill also caps them at an income threshold that is lower than the one stipulated by the ACA. This would make it more difficult for middle-income Americans to receive the financial support they need to pay for coverage.”

“The ACR supports the Senate’s decision to include an appropriation for cost-sharing subsidies through 2019. These payments are vital to maintaining stability in the individual insurance marketplace and ensure that low-income Americans are afforded smaller out-of-pocket costs. It is the uncertainty around these payments that prompted some insurers to increase premiums while others were forced out of the marketplace altogether.”

“As the Senate moves forward with this legislation, we will continue to assess the bill language and its potential effects, as well as the forthcoming score from the Congressional Budget Office. The ACR hopes to work with members of the Senate to address these concerns so that the millions of Americans living with rheumatic diseases can continue to access the care they need.”

The ACR has also come out in favor of the re-Introduction of "Patients’ Access to Treatment Act".

The American College of Rheumatology (ACR) issued a statement applauding the leadership of Rep. David McKinley (R-WV) and Rep. G.K. Butterfield (D-NC) in reintroducing H.R. 2999, the Patients’ Access to Treatment Act (PATA). The bipartisan legislation would limit cost‐sharing requirements for medications placed on specialty insurance tiers and make innovative and necessary therapies more accessible to Americans living with rheumatic diseases by reducing excessive out‐of‐pocket expenses.

“The ACR applauds the reintroduction of the Patients’ Access to Treatment Act and the bipartisan effort by Rep. David McKinley and Rep. G.K. Butterfield to make biologic therapies more accessible and affordable for Americans living with rheumatic diseases,” said Dr. Angus Worthing, MD, practicing rheumatologist and chair of the ACR’s Government Affairs Committee. “It is a travesty that even with health insurance, Americans are finding it increasingly difficult to afford the therapies prescribed by their doctors to help them manage their disease, avoid permanent disability, and lead active, full lives. No one living with a chronic disease should have to choose between their physical and financial health. We implore Congressional leaders to enact PATA this session and in doing so, take an important step toward ensuring all Americans can access necessary and life-changing drugs.”

Nearly 20 percent of employer health insurance programs and 85 percent of Medicare plans now place the most expensive and innovative drugs on so-called “specialty tiers” that require patients to pay a percentage of the actual cost of the drugs, rather than a fixed co-pay amount each month. According to a 2015 Pew Charitable Trusts report, the number of Americans with annual drug costs greater than $50,000 increased 63 percent in 2014, with 92 percent of those patients using high-priced specialty drugs. The same report found that some health plans charge a co-insurance payment as high as 33 percent.

With the average annual price of biologic therapies ranging from $15,600 - $36,000, patients who are prescribed biologics on specialty tiers must pay hundreds or thousands of dollars in copayments each month or go without treatment due to prohibitive costs. PATA would make specialty drugs more affordable by limiting cost-sharing requirements, thereby improving patient access to life-saving drugs, reducing disability, and stemming the rising healthcare costs associated with rheumatic diseases.

More than 11 million Americans suffer from inflammatory rheumatic diseases such as rheumatoid arthritis, juvenile idiopathic arthritis, gout, and lupus. Biologic drugs have been used to successfully treat many patients living with these painful and debilitating diseases.

The American College of Rheumatology (ACR) is the nation's leading advocacy organization for the rheumatology care community, representing more than 9,500 rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable and accessible rheumatology care.

The author has no conflicts of interest to disclose related to this subject

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