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  • Dr. Chris Phillips

How the Affordable Care Act Impacts Rheumatic Disease Patients


Did you know that an estimated 54.4 million adults in the United States have arthritis? That’s on average 1 in 4 people.


Arthritis, or joint inflammation, is the leading cause of disability among adults residing in the United States, limiting everyday activities for 24 million Americans.


“With the aging of the US population, the prevalence of doctor-diagnosed arthritis is expected to increase in the coming decades. By the year 2040, an estimated 78.4 million (25.9% of the projected total adult population) adults aged 18 years and older will have doctor-diagnosed arthritis ...” (source: The Arthritis Foundation)


These statistics from the Centers for Disease Control and Prevention are eye-opening. Rheumatic diseases are extremely prevalent, and that means there is an urgent need for affordable health insurance to help mitigate the costs of living with an autoimmune or inflammatory disease.


According to an article by the Arthritis Foundation, the U.S. Supreme Court upheld the Affordable Care Act (ACA). This landmark health care law was passed in 2010.


“The 7 to 2 ruling puts an end to a three-year battle over the future of the ACA and provides assurance that the key features we know many people with arthritis rely on will remain intact — such as Essential Health Benefits like prescription drugs, annual out-of-pocket cost limits, the ability of young people to stay on their parent's insurance until age 26, and a prohibition on discrimination based on pre-existing conditions,” according to The Arthritis Foundation (article source).


On the contrary, a ruling in the opposite direction would have created what The Arthritis Foundation considers, “a major ripple effect and massive disruptions in health care.” This act went on to impact many other provisions that are now cornerstones of the healthcare market, including Health Exchanges and Medicaid expansion. In addition, lesser-known provisions also stemmed from the Affordable Care Act, such as the creation of a pathway to approve biosimilar products. Of these products, 5 are now on the market for arthritis.


As a healthcare provider, I witness firsthand the life-transforming benefits of prescribed medications. For this reason, I am grateful for the insurance coverage some of my patients have through the ACA, especially considering they would otherwise have to go without.


But far too often, insurance coverage or the lack thereof turns into a barrier for effective treatment. Working as a rheumatologist, I see numerous patients that are uninsured or underinsured due to high deductibles. Moreover, increasingly powerful pharmacy benefit managers take clinical decision-making out of the hands of the provider and patient through burdensome step-edit and fail-first policies. And it doesn’t help that medication costs keep rising too.


The battle to be able to provide clinically appropriate and cost-effective care for patients with rheumatic diseases has not yet been won and is ongoing on multiple fronts.


I am grateful for advocates through the American College of Rheumatology, Arthritis Foundation, and other organizations that continue to fight for access to appropriate care for our patients. Thank you!


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