Affordable Care Act Resources
Prior to the Affordable Care Act (ACA), cancer survivors were at the mercy of the health care system, often forced to pay exorbitant premiums or simply denied coverage altogether. Today, America’s 16 million cancer survivors benefit from the ACA’s patient protections that are critical to providing them with quality, affordable, and accessible health care coverage. NCCS is actively engaged in advocating to ensure this unprecedented access continues.
On this page we provide regular updates on this ongoing debate, what it means for cancer survivors, and how survivors and advocates can make their voices heard.
How Can I Get Involved?
Take Action
Call Your SenatorsMeet Your Members of Congress In Person
Meet with your Members of Congress at district events. Find a town hall meeting near you »
A quick visit to share my healthcare story & thank @RoKhanna for his efforts to #ProtectOurCare w/ @sfuldnasso of @CancerAdvocacy #CPAT17 pic.twitter.com/r0eoqGfurl
— Stacey Tinianov (@coffeemommy) June 27, 2017
Check out our printable PDF tip sheet to help you prepare for calls, meetings, and town hall events. The sheet also contains sample questions to ask your Members of Congress.
NCCS Is Here to Help
We are happy to assist you in these advocacy efforts to support cancer patients and survivors. If you are interested in scheduling a meeting either in your local Congressional office or in Washington DC, please email our Public Policy Manager, Lindsay Houff, at lhouff@canceradvocacy.org.
Another important way you can make your voice heard is through op-eds in local newspapers. NCCS would love to help you draft an op-ed and provide instructions on getting the article published.
Social Media
Engage with Members of Congress on their social media platforms. Comment on their Facebook pages, or tweet directly at them (use the hashtag #ProtectOurCare). They and their staff DO pay attention to these things.
C-Span’s List of Congressional Twitter Handles »
Do you have questions or need assistance? We can help you set up meetings with your Members of Congress.
Please contact Lindsay Houff, Manager of Policy at lhouff@canceradvocacy.org.
ACA Status Updates
Your feedback is always welcome to make our content more useful to you. Please send comments to feedback@canceradvocacy.org.
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HEALTH CARE HIGHLIGHTS
Trump Administration Promotes a Drug Pricing Plan
On Friday, May 11, 2018, President Trump announced a drug pricing blueprint to address prescription drug prices. Initial media coverage of the plan suggested that the blueprint failed to honor the President’s campaign commitment to negotiation of drug prices. Overall, the press and policymaker reaction to the plan was muted, with some suggesting that the plan would have limited impact. Although details of the plan are still unclear, certain elements of the plan may have an impact on how cancer patients receive and pay for their prescription drugs. There may be changes in the coverage and payment for both intravenous, physician-administered cancer drugs and oral, self-administered cancer therapies. The public has 60 days to comment on the drug pricing plan through the “Request for Information” released by the Trump Administration. NCCS will evaluate the direct patient impact of the plan provisions that relate to coverage and payment for cancer drugs and will outline the issues of concern to cancer patients.
Insurance Premium Increases for 2019, the Causes, and Efforts to Lower Them
Insurers have begun to project next year’s premiums for plans offered through the Affordable Care Act (ACA) marketplaces. The premiums that have been announced to date for 2019 are significant increases over premiums in 2018. Insurance companies signaled that adjustments to the premiums are possible if they receive relief from the costs associated with insuring expensive patients. Members of Congress are blaming each other for the premium increases. Congressional Democrats contend that the actions of the Trump Administration to undermine the ACA enrollment process and to advance short-term, limited-duration plans will further undermine the ACA marketplaces. The Trump Administration and some Congressional Republicans maintain that the ACA is fundamentally flawed and that repeal is still necessary. The Hill has reported that rate increases have reignited the “Obamacare war.” In fact, Senator Lindsay Graham is reportedly working on a “new” Obamacare repeal bill.
Short-Term Plans: Enrollment will be Significant and Negative Effects on Marketplace will be Substantial
The Trump Administration’s proposed expansion of short-term plans will reportedly be finalized by June 2018. These plans, sometimes called “skinny” or even “junk” plans, will not be required to meet ACA standards for benefits, cost-sharing, guaranteed issue, and pre-existing condition protections. The Administration has touted these plans as an affordable insurance option for healthy adults and has suggested that uptake of the plans will be slow and the impact on the ACA health insurance marketplaces will be modest.
This week, the Actuary of the Centers for Medicare & Medicaid Services (CMS), who is independent from the CMS leadership, projected that 1.8 million Americans would elect short-term coverage, with 800,000 coming from the ACA marketplace. This projection means that almost 2 million Americans will have only short-term coverage of limited scope and significant cost-sharing burden and that the diversion of hundreds of thousands from the marketplace will destabilize the ACA marketplace. For cancer patients who rely on ACA coverage, premiums will increase, potentially substantially, if they are not eligible for premium subsidies. The expansion of short-term plans will also cost the federal government $38.7 billion over ten years with increased expenditures for premium subsidies, the CMS Actuary reported.
CHART OF THE WEEK
A Kaiser Family Foundation report entitled, “Implications of the ACA Medicaid Expansion: A Look at the Data and Evidence,” reported that “Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates compared to non-expansion states for the low-income population broadly.”
IMPORTANT READS
Healthy America, a big new plan to combine Medicaid and Obamacare, explained
Via Vox.com
The Urban Institute, a think tank in Washington, DC, has acknowledged the deep divide about the ACA and the renewed push to repeal the ACA. They have proposed an alternative that protects employer-based insurance and Medicare and creates a new system for individual and families seeking health insurance coverage. Premiums in the system would be income-based and premium subsidies would be available for those who need them. The plan would also impose limits on provider payments and other cost controls would be implemented to control premium costs. The Urban Institute plan includes a chart that compares a wide range of health care reform proposals, identifying the strengths and weaknesses of each.
More men with low-risk prostate cancer are forgoing aggressive treatment
Via Washington Post
In a study published in the Journal of the American Medical Association (JAMA), researchers reported that men with low-risk prostate cancer are increasingly choosing active surveillance of their disease instead of surgery and radiation. The study, which included more than 125,000 men with prostate cancer treated between 2005 and 2015, found a major shift in treatment decisions over that decade. In 2005, only 27 percent of men under age 65 chose watchful waiting instead of active treatment. By 2015, that proportion had grown to 72 percent. Cancer care experts are applauding the shift in treatment choices, which spares men the serious side effects of treatment and results in comparable outcomes.
CMS considers paying all Medicare providers for cancer gene therapies
Via Modern Healthcare
The Centers for Medicare & Medicaid Services (CMS) has initiated a review of how and under what terms the Medicare program will cover the recently approved CAR T-cell therapies. These therapies have provided significant benefits to certain leukemia and lymphoma patients. Some patients experience serious side effects from the treatments. Public comment on the review is accepted until June 15, 2018. A public meeting will be held on August 22, 2018. The final decision is due on February 16, 2019.
A new weekly roundup of policy news affecting the cancer community.
In order to bring you the latest cancer-related health care policy and news, we at NCCS are combining our ACA Updates and What Caught Our Eye (WCOE) content into a weekly email and blog post. We aim to make this a concise, one-stop summary of what you need to know as we continue working together to make cancer care better for everyone.
Your feedback is always welcome to make our emails more useful to you. Please send comments to feedback@canceradvocacy.org.
Subscribe to our email list and receive these updates in your email box each week »
Thank you for your support of NCCS.
HEALTH CARE HIGHLIGHTS
Proposed CHIP Cuts
This week the Trump administration proposed a $15.4 billion package of spending cuts across 10 federal departments, with half of the cuts expected to come from CHIP (Children’s Health Insurance Program). As the Georgetown Center for Children and Families reports, following the bipartisan agreement earlier this year to extend CHIP funding for ten years, it was surprising to hear that the administration wants to cut CHIP funds. Two billion dollars in cuts would come from the Child Enrollment Contingency Fund. The Contingency Fund is a “rainy day” fund put in place to help prevent states from running out of money. Contingency Fund dollars are made available to states if they experience an unexpected surge in enrollment, perhaps due to natural disasters or an economic downturn, ensuring that eligible children can continue to get covered.
Association Health Plans Hidden in Farm Bill
There are more health care policies emerging from an unlikely place: the farm bill. Kaiser Family Foundation reports that in the House version of the massive bill—amid crop subsidies and food assistance programs—is a provision that would provide less comprehensive health insurance through associations than plans offered through the Affordable Care Act. It calls for $65 million in loans and grants administered by the Department of Agriculture to help organizations establish agricultural-related “association” type health plans. Under that proposal, association plans would not have to offer coverage across 10 broad “essential” categories of care, including hospitalization, prescription drugs and emergency care. They could also spend less premium revenue on medical care.
Premium Increases
Insurance companies in Virginia and Maryland announced significant health care premium hikes and cited the administration’s actions as reasons for the rising rates, including repeal of the individual mandate. They also said they expect more increases in the fall. Read more on Bloomberg.com »
Drug Prices
Lastly, this afternoon, the White House announced a plan regarding the high cost of prescription drugs in the U.S. Preliminary analyses suggest that the policy proposals will have a relatively modest impact, but NCCS will continue to review the plan and follow these issues as they develop.
CHART OF THE WEEK
This is a chart shared by Sarah Kliff at Vox.com from a study that looked at the variation of MRI costs within a hospital based on contracts with different payers. Very interesting insights about the contributing factors of the high price of care in the United States. Read more about the study here »
IMPORTANT READS
‘World-first’ call for exercise to be prescribed to all Australian cancer patients
Via ABC News (Australia)
An interesting article that outlines how 25 health organizations in Australia are recommending that exercise be prescribed to all cancer patients. “’We’re at a point where the level of evidence is really indisputable and withholding exercise from patients is probably harmful,’ said Associate Professor Prue Cormie, who is chair of the COSA report group and lead author of the statement.”
What’s on the Trump administration’s $15B cost-cutting list
Via Politico
As mentioned above, the Trump administration sent a $15.4 billion dollar package of suggested cuts in federal spending to Congress. What caught NCCS’ eye and raised concern is where some of these cuts would occur. Namely, $6.96 billion cut from the Children’s Health Insurance Program, which helps provide health insurance to low income families and children, helping to cover cancer treatments for those affected. Second, $800 million from the Center for Medicare and Medicaid Innovation (CMMI), which is developing new models to reduce costs and improve care, including for those facing cancer. As noted, the chances of this passing the Senate are slim, but only requires a simple majority.
For mothers with advanced cancer, parenting concerns affect emotional well-being
Via UNC Lineberger News
This headline will come as no surprise to many who have a cancer experience. But as patient-centeredness continues to gain momentum in both cancer care and research, we’re beginning to see more studies like this one. The physical implications of cancer are well documented, and now we are beginning to learn more about the psychological trauma cancer causes as well. One item to highlight is that the study authors “found that parenting concerns were significantly associated with lower quality of life—almost as much as declines in day-to-day physical functioning.” Hopefully, this will eventually lead to more support for parents facing these situations.
NCCS recently hosted a webinar on what these short-term plans mean for cancer survivors. See the webinar blog post for step-by-step instructions on how to submit comments to ensure cancer patients’ voices are heard.
How to Voice Opposition to the Proposed Rule for Short-Term Limited Duration Coverage
Another ACA development occurred this week. Last year, the Trump administration halted cost-sharing reduction (CSR) payments, which reduced out of pocket spending for consumers. But insurers may get their CSR payments after all, as a federal court has allowed a lawsuit to proceed against the administration over these CSR payments.
Axios explains what’s happening:
We will keep you updated as the issue develops.
Related Post
ACA Update March 23, 2018 | Congress Passes Spending Bill, Leaves Out ACA Market Stabilization
These plans can deny coverage due to a preexisting condition or charge people more based on their health status, impose annual or lifetime limits, and fail to cover essential health benefits. Because short-term plans provide skimpy coverage, these plans are much cheaper and will appeal to healthy people, who will likely leave ACA-compliant plans. This would seriously undermine the ACA risk pool and drive up Marketplace premiums for people, like cancer survivors, who need the protections that Marketplace plans provide.
This week, NCCS hosted a webinar about the proposed rule on short-term limited-duration health plans.
In the webinar, JoAnn Volk, MA, from the Georgetown University Center on Health Insurance Reforms, provided a detailed description of what short-term plans are and how they would harm patients. NCCS CEO Shelley Fuld Nasso and Public Policy Manager Lindsay Houff then outlined what patients and advocates can do to stop this rule from becoming policy.
NCCS urges advocates to submit comments on the Regulations.gov website to ensure cancer patients’ voices are heard. Short-term plans would be dangerous for people who purchase them, and threaten the entire market for those who don’t.
The deadline to submit comments is April 23.
See our blog post to find instructions on how to submit comments, a template comment letter, and the webinar video
How to Voice Opposition to the Proposed Rule for Short-Term Limited Duration Coverage
Earlier this week, Iowa passed a law allowing the sale of health plans that are not subject to the important patient protection rules and regulations contained in the Affordable Care Act (ACA).
The law includes very specific carveout language that basically selects the Iowa Farm Bureau to partner with a designated insurance company (Wellmark) to offer so-called “health benefit plans” with no preexisting condition or essential health benefit protections. As such, the law allows certain health plans to discriminate against those with preexisting conditions and exclude certain benefits—anything from prenatal care to prescription drugs.
Iowa’s found a new, likely legal way to ignore Obamacare https://t.co/JzkpK6xpPS
— Vox (@voxdotcom) April 4, 2018
As Vox.com reports, it does this in a way that most experts think is perfectly legal—by making clear in the new legislative language that these products are not health insurance. The insurance department in Iowa won’t regulate these plans as health plans. Therefore, they don’t have to play by Obamacare rules.
Health policy experts say the legislation is unusual because few states have tried to take themselves out of regulating health insurance. This is yet another attempt to undermine the ACA after legislative attempts to repeal the law failed last year in Congress.
In addition to the Iowa action, the Trump administration is also actively sabotaging the ACA through regulatory means, as we have reported.
In February, the administration released proposed rules that would loosen regulations on short-term limited-duration health insurance coverage.
Short-term coverage is not subject to the ACA’s patient protections and can deny coverage due to a preexisting condition or charge people more based on their health status, impose annual or lifetime limits, and fail to cover essential health benefits. Because short-term plans provide skimpy coverage, these plans are much cheaper and therefore healthy people will likely leave ACA-compliant plans for short-term coverage, which would seriously undermine the ACA risk pool and drive up marketplace premiums for people without tax credits.
There is an opportunity to submit comments to the Federal Registrar to explain how this proposal would negatively impact cancer survivors, and the threat posed to individuals who will be diagnosed with cancer in the future.
Next week, NCCS will be hosting a webinar to provide background information on the proposed rule and step-by-step instructions on how to submit comments to influence the regulatory process and stand up for patients. For more information about registering for the webinar, contact Lindsay Houff at lhouff@canceradvocacy.org, or use our “Contact Us” form.
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Beginning last summer, Senators Alexander and Murray were working on a bipartisan package that would aim to stabilize the ACA through cost-sharing reduction payments, outreach funding and reinsurance funding. In early December, Senator Collins pledged her vote on the Republican tax bill in exchange for ACA stabilization funding.
Last night, the House refused to put the ACA measures in the bill after objections by conservative Republicans over “bailouts” for insurance companies and by Democrats opposed to restrictions in the bill limiting abortion coverage. Senator Murray objected to Senator Collins’ attempt to add the bill as an amendment-and urged lawmakers to instead resume work toward a bipartisan agreement on shoring up the health law. She then offered a competing stabilization amendment, which was shot down by Majority Leader Mitch McConnell.
The spending package will carry the government through the end of the fiscal year.
While there was no part of the Senate proposal to shore up the Affordable Care Act’s insurance markets—neither cost sharing reduction payments nor reinsurance funding—there were a few health care components, as Axios reports:
Related Posts
As we reported recently, Idaho regulators announced they would allow the sale of insurance plans that don’t adhere to the Affordable Care Act’s (ACA) requirements and patient protections. Blue Cross of Idaho was planning to sell insurance plans that are priced based on applicants’ health status.
However, in the letter she provided some further clarification, saying: “We believe that, with certain modifications, these state-based plans could be legally offered [as] short-term, limited-duration plans. I encourage you to continue to engage in a dialogue with my staff regarding this and other potential options.”
The Department of Health and Human Services already said that consumers can keep bare-bones, short-term health plans for up to a year. HHS secretary Alex Azar told reporters yesterday that HHS also wants consumers to be able to renew those plans for more than one year. As health experts have pointed out, if these short-term plans are renewable, they are basically the same as pre-ACA plans that did not have to include critical services like prescription drugs, hospital visits or trips to the ER. Additionally, allowing guaranteed renewal for short-term plans would NOT protect consumers from premium increases. Enrollees can and will be charged more if they get sick after they enroll.
Larry Levitt of Kaiser Family Foundation sums it up well: “The federal government is reining in Idaho, preventing it from allowing insurance plans that don’t comply with the ACA. But, it strongly suggests the state may be able to accomplish the same thing using ‘short-term’ plans as a vehicle.”
Another development surrounding short-term plans and the ACA is a new bill introduced by Senator John Barrasso (R-WY) that would move the individual market another step further towards having separate, parallel marketplaces for sick and healthy people. A legislative push – which appears to be backed by some in the White House – would allow short-term plans to both be available for up to a year and to have guaranteed renewability.
What the bill does, according to Axios:
These are incredibly concerning developments, especially for the millions of cancer survivors who depend on access to affordable, quality health care. NCCS is continuing to monitor these actions and finding ways to highlight the needs of survivors in this debate.
If you would like to get involved, please contact our Public Policy Manager, Lindsay Houff, lhouff@canceradvocacy.org.
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