Any replacement to the Affordable Care Act needs to “protect and promote access to adequate and affordable health insurance for all citizens,” urged a letter from The American College of Rheumatology to House and Senate leaders.

The ACR recommended that coverage should be “continuous,” as well.

In keeping with its focus on arthritis and rheumatic diseases, it specifically advised that any such health care “would include treatment for arthritis and rheumatic diseases with access to a rheumatologist and other rheumatology health professionals for both consultative and maintenance care.”

“One in six Americans live with rheumatic diseases, making it the nation's leading cause of disability," said ACR President Dr. Sharad Lakhanpal.

"Early and appropriate treatment for rheumatic diseases like arthritis and lupus, provided by trained rheumatologists, can prevent or slow disease progression, decrease the likelihood of disability, and reduce long-term health care costs,” he added.

The Centers for Disease Control and Prevention now estimates that the number of Americans with arthritis diagnosed by a doctor will rise to one in four by the year 2040 — as will associated health care costs.

The letter stressed that the ACR “looks forward to working with both Congress and the incoming Administration,” in developing a way to guarantee that there is access to “affordable, high-quality health care, including care for arthritis and other rheumatic diseases."

In order for this to happen, it is essential to “maintain the ban” that keeps insurance companies from refusing coverage to a person because of a pre-existing condition, the association stressed.

In addition, the letter stipulated that a number of other aspects of ACR be kept in any replacement legislation, including:

• Insurance coverage for rheumatic disease specialists and services;


• Coverage of health educational activities for patients with chronic illnesses;


• Limits on patient copayments for specialty drugs and services;


• Ongoing recognition that laboratory, radiological, and infusion services should be “conveniently close” to the location of a rheumatology patient's medical care

The letter stressed the need to ensure clinical rheumatologists are able to run viable medical practices, as well. To that end, the ACR suggested that changes be made to a number of other aspects of the ACA, including:

• Repealing of the Independent Payment Advisory Board provision;



• Cutting administrative overhead by using universal prior authorization systems for multi-state health plans;


• Maintaining FDA oversight of the safety and effectiveness of biosimilars “to encourage market-based relief from the high costs of biologic drugs”

The ACR letter comes just weeks after a similar one from the American Medical Association.

“In considering opportunities to make coverage more affordable and accessible to all Americans,” wrote AMA CEO Dr. James L. Madara to House and Senate leaders, “it is essential that gains in the number of Americans with health insurance coverage be maintained.”

The letter then went on to state that, “Consistent with this core principle, we believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.”