Editor’s note: After several previous attempts to repeal the Affordable Care Act (ACA) failed, another attempt is nearing a vote in the U.S. Senate.
Senators Lindsay Graham (R-South Carolina), Bill Cassidy (R-Louisiana), Dean Heller (R-Nevada), and Ron Johnson (R-Wisconsin), are pushing a new bill that would allow states to waive important patient protections, like essential health benefits, and would significantly reduce funding for cost-sharing subsidies. The bill would also end the expansion of Medicaid and reduce funding for the traditional Medicaid population.
The senators are trying to get their bill passed in the Senate by Sept. 30, because as of Oct. 1, Senate rules dictate that 60 votes will be required to pass such legislation, up from 50 currently.
The AACR has significant concerns about this and all previous attempts to repeal the ACA. The AACR organized a session during the 2017 AACR Annual Meeting titled “The Potential Impact on Cancer Patients of a Repeal or Revision to the Affordable Care Act.” The blog post below includes information from that session, as well as comments and observations from members of the AACR’s Health Policy Subcommittee and its chair Gil Omenn, MD, PhD.
On behalf of the 37,000 members of the American Association for Cancer Research (AACR), we call on Congress to ensure that any reform to our nation’s health care system includes protections for the many Americans who have experienced acute and chronic diseases, including cancer.
Access to comprehensive health insurance is important to all Americans, especially to the 1.7 million who will be diagnosed with cancer in 2017. The Affordable Care Act (ACA) provided major benefits for those affected by cancer, including a prohibition on the denial of insurance coverage based on pre-existing conditions; Medicaid expansion; dependent coverage until age 26; a prohibition of annual and lifetime coverage caps; support for participation in clinical trials; and coverage of prevention, early detection, treatment, and survivorship services. Any replacement to the ACA should maintain these vital provisions.
An estimated 27 percent of adults in the United States under age 65 have pre-existing conditions. This includes more than 15.5 million who are cancer survivors. Prior to the implementation of the ACA, many of these Americans would have been denied coverage had they applied for individual market plans. Additionally, prior to the ACA, many insurers maintained a list of certain drugs, including anti-cancer medications, which would warrant denial of insurance for those taking them. This, too, left many cancer survivors without coverage. Finally, under the ACA, children may stay on their parents’ insurance policies until age 26. This is a major benefit to pediatric and young adult cancer patients and survivors.
Medicaid provides low-income Americans with quality, affordable, and comprehensive health care, making it a critical safety net for many cancer patients and survivors who need lifesaving preventive and treatment services. In 2013, according to the National Program of Cancer Registries, at the time of diagnosis, 32 percent of pediatric cancer patients had Medicaid. Additionally, in 2015, nearly 1.52 million Americans aged 18-64 with a history of cancer relied on Medicaid for health care services.
These numbers are higher now, with the expansion of Medicaid in more than 30 states. Therefore, it is critical that any replacement to the ACA should maintain Medicaid expansion, as any cuts to Medicaid will cause a significant negative impact on the health of poor Americans, many of whom face disparities in cancer outcomes, and many middle-class Americans who lost their incomes and face high costs due to cancer diagnoses.
Another important provision of the ACA is the prohibition on annual or lifetime limits. Prior to the ACA, 105 million Americans were enrolled in health plans that included lifetime or annual limits on health benefits, which posed a tremendous hurdle for cancer patients, whose cancer treatment costs often exceeded these caps. Moreover, recent novel breakthroughs in cancer treatment, such as immunotherapy, are complex and expensive and would be out of reach for many patients if coverage limits are reinstated. Any new health care plan should maintain the ACA prohibition on such coverage caps.
Many of the 10 Essential Benefits mandated under the ACA are vital for preventing and detecting cancers at earlier stages, when they are more treatable at a lower cost. Access to services such as cancer-preventing immunizations, tobacco cessation programs, and colorectal, lung, breast, and cervical cancer screenings are instrumental in reducing the likelihood of developing or dying from cancer. For patients to benefit from recent advances in cancer screening and prevention, any replacement to the ACA should maintain affordable access to these preventive services.
Finally, our health care system must support patient enrollment in clinical trials; therefore, we urge Congress to take this provision into consideration when reviewing legislation. Policies that require coverage of the routine costs to patients (such as office visits, lab tests, supportive care drugs) of an approved clinical trial will encourage more patient participation and enhance rapid translation of science into new therapies for patient benefit.
We stand ready to work with Congress on behalf of cancer patients, families, and survivors to ensure that vital provisions covering cancer prevention, detection, diagnosis, treatment, and survivorship are included in any replacement or revision to the ACA.
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