Medical Groups Concerned That AHCA May Limit Access to Care

Rheumatology Practice Management April 2017 Vol 5 No 2 - Health Policy
Leslie Wyatt

In early March 2017, American College of Rheumatology (ACR) President Sharad Lakhanpal, MBBS, MD, released a statement asserting the ACR’s position on the controversial American Health Care Act (AHCA). Citing the commitments of ACR and the Association of Rheumatology Health Professionals (ARHP) to improving the access and affordability of healthcare insurance to the 54 million Americans living with lasting, incapacitating, and painful rheumatic diseases, Dr Lakhanpal voiced the organization’s concern that the AHCA limits access to care for these patients.

“The ACR/ARHP has outlined specific provisions that would need to be included in an ACA replacement bill to ensure Americans have continued access to rheumatology care that lowers long-term costs and helps patients manage pain, avoid long-term disability, remain active in the workforce, and preserve their quality of life,” he said in the press release.

Dr Lakhanpal noted that, following a comprehensive review of the AHCA text, the ACR was encouraged by the act’s conservation of several key provisions that are vital in ensuring that patients can access and afford their healthcare. These provisions include having no exclusions for preexisting conditions, limitations on patient copayments, caps on out-of-pocket expenses, coverage for children through to age 26 years on a parent’s insurance plan, and a ban on lifetime limits.

ACR Concerns Regarding AHCA Provisions

The statement also shed light on the ACR’s apprehension about certain AHCA provisions.

“We are concerned that some provisions of the AHCA could make it harder for our patients to access rheumatology care. The proposed tax credits based on age rather than income may be insufficient for many rheumatic disease patients to obtain adequate private health insurance coverage. We are also concerned by a provision that would allow insurers to impose a 30% premium increase for 12 months for those who have let coverage lapse for more than 63 days,” Dr Lakhanpal said.

He further elucidated the ACR’s stance on the AHCA by noting that the act does not address the organization’s recommendations to reduce the administrative burden physicians face and to rescind the Independent Payment Advisory Board, but concluded the statement on a hopeful note.

“These provisions would go a long way toward ensuring a thriving rheumatology workforce and continued patient access to care. We look forward to working with Congressional leaders and the Administration to address these concerns and will continue to provide input on proposed legislation to ensure continued access to vital rheumatology healthcare services,” Dr Lakhanpal stated.

Arthritis Foundation Echoes ACR Apprehension

In a separate statement released later in March, the Arthritis Foundation expressed opinions similar to those of the ACR in response to the AHCA. In addition to voicing concerns regarding access to and affordability of healthcare for individuals with arthritis, the foundation re­iterated encouragement for the AHCA’s maintenance of the key provisions laid out by Dr Lakhanpal.

The Arthritis Foundation also revealed apprehension regarding barriers to care that could come about as a result of the AHCA, including:

  • Many patients with arthritis risk losing insurance coverage because of Medicaid expansion being revoked, and because of changes in eligibility criteria
  • In the event that Essential Health Benefits are no longer required to be a part of an insurance plan, access to prescription drugs and critical outpatient care will be disrupted for patients with arthritis
  • Coinsurances may increase in the event of a cost-sharing subsidy repeal, which, in turn, would reduce patient access to life-altering therapies
  • The 2018 rollback of the Prevention and Public Health Fund, which supports the Centers for Disease Control and Prevention—the only national organization that collects data from across the country regarding arthritis.

In its statement, the foundation also briefly discussed a recent summit its members attended in preparation for the impending legislation.

“On March 8, The Arthritis Foundation and its Advocates met with 245 members of Congress as part of the Advocacy Summit so that they could hear directly from patients to ensure that proposed legislation meets the needs of all Americans, especially those who have a chronic disease,” the statement read.

The Arthritis Foundation concluded the press release with a positive message regarding anticipation of continued dialogue about these topics in the weeks to come, and expressed hope that legislators and administrators will actively pursue ongoing feedback from patients.

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