Affordable Care Act Resources

Affordable Care Act - #ProtectOurCare

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.

Current Status 6/27: The Department of Justice (DoJ) determined that it will NOT defend the Affordable Care Act (ACA) in the lawsuit filed by the state of Texas and several other states. (Read More here.) If the position of the DoJ is upheld by the courts, the pre-existing condition protections that are critically important to cancer patients will be eliminated.

On June 27, a number of NCCS CPAT advocates and others with pre-existing conditions participated in a press conference highlighting how vital these protections are for patients with chronic illness. Thank you to NCCS CPAT Members Randy Broad and Jamie Ledezma for sharing their story. Watch the press conference stream »


How Can I Get Involved?

Contact/Meet Your Members of Congress
Whether you attend a town hall event in your district, set up an in-person meeting with the district office, or call your Member, every effort is vital in saving our care. Did you know it takes on average only SEVEN phone calls for Members of Congress to flag an issue?

Take Action

Call Your Senators

NCCS has set up a toll-free number so you can easily call and be directly connected to the offices of your Senators. Call your Senators at (844) 257-6227 and urge them to oppose repeal of the medical expense deduction and the individual mandate.  We must work on constructive solutions that improve our health care system for all Americans.

Meet Your Members of Congress In Person

Meet with your Members of Congress at district events. Find a town hall meeting near you »

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

In order to bring you the latest cancer-related health care policy and news, we at NCCS combined 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 content 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 »


HEALTH CARE HIGHLIGHT

NCCS and 30+ Patient Orgs Raise Concerns Over Senate Pre-Ex Bill

This week, NCCS and more than 30 other patient advocacy organizations submitted a letter to Senator Tillis (R-NC) detailing why his bill does not go far enough in protecting pre-existing conditions despite his intentions. The bill title, “Ensuring Coverage for Patients with Pre-Existing Conditions Act” (S.3388), is misleading and, if passed, would not provide adequate coverage for those covered under current law with pre-existing conditions.

The reason is that while the bill requires insurers to provide health care plans to people regardless of health, it does not require the insurers to cover the costs of the care for the pre-existing condition itself.

NCCS and others stated in the letter:

We share your interest in continuing to make health insurance accessible to Americans with pre-existing conditions and appreciate your efforts to preserve certain protections in law, regardless of the outcome of Texas vs. US. However, the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” as currently drafted, falls far short of providing coverage and security to your constituents.

The bill is seen by many as an attempt to calm fears related to the Texas lawsuit challenging the constitutionality of the ACA. If that lawsuit is eventually successful, it would wipe out the pre-existing condition protections millions of Americans have come to rely on.

Read the full letter »


CHART OF THE WEEK

The ACA’s Pre-Existing Condition Protections Remain Popular with the Public, including Republicans, As Legal Challenge Looms This Week

Kaiser Family Foundation

As there are several pending lawsuits that aim to either attack or protect the ACA, we thought it was important to share this chart again by KFF that shows how important pre-existing condition protections are for the vast majority of Americans.


IMPORTANT READS

Key Flaws of Short-Term Health Plans Pose Risks to Consumers

Via Center on Budget and Policy Priorities

On October 2, federal rules take effect that will fundamentally change how short-term health plans are administered. This article serves as another reminder of why these changes are so concerning, namely:

In most states, short-term plans are exempt from pre-existing condition protections and benefit standards that individual-market plans must meet.

Read More »

Denied ‘life-extending opportunities’: Black patients are being left out of clinical trials amid wave of new cancer therapies

Via STAT News

This report provides compelling evidence that clinical trials continue to have meaningful racial disparities. It specifically looks at a clinical trial for a new drug for multiple myeloma, where one out of five people diagnosed in the US are African-American. In the trial however, only 1.8 percent of participants were African-American.

The racial disparity in the Ninlaro study isn’t unusual. Reflecting the reluctance of the FDA to force drug makers to enroll more minority patients, and the failure of most manufacturers to do so voluntarily, stark underrepresentation of African-Americans is widespread in clinical trials for cancer drugs, even when the type of cancer disproportionately affects them. A ProPublica analysis of data recently made public by the FDA found that in trials for 24 of the 31 cancer drugs approved since 2015, fewer than 5 percent of the patients were black. African-Americans make up 13.4 percent of the U.S. population.

Read More »

Cancer Coaches Help Guide Patients During and After Treatment

Via Wall Street Journal

This article highlights the increasing use of “cancer coaches” to help guide patients through a cancer experience. While it is helpful that patients have somewhere to turn for additional assistance, it raises serious ethical concerns that only patients with financial means can afford this level of care.

Read More »

Young Adult Cancer Action Day: Advocating for Young Adult Survivors

Via The Bloodline With LLS (Podcast)

An informative interview with Kate Houghton, of Critical Mass, about the “Deferment for Active Cancer Treatment Act” (H.R. 2976). This bill “calls for federal student loan borrowers to be eligible for deferment while they are receiving treatment for cancer.”

Read More »


Related Posts

Health Care Roundup: Maryland, Advocacy Groups File Suits to Protect ACA; Emergency Resources for Survivors; False Hope in Precision Medicine; More

Health Care Roundup: Texas Court Hears ACA Lawsuit; House, Senate Advance Pharmacy “Gag Clause” Bans; Long-Distance Caregiving; and More

In order to bring you the latest cancer-related health care policy and news, we at NCCS combined 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 content 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 »


HEALTH CARE HIGHLIGHTS

2017 Insurance Coverage Statistics

This week, the US Census Bureau released health insurance coverage estimates for 2017. Between 2016 and 2017, the overall uninsured rate did not change significantly, but 14 states experienced an increase in the number of uninsured individuals, due to poverty status or whether the state expanded Medicaid.

While coverage numbers dropped in many states, the Trump Administration continues to cut ACA navigator funding, which helps individuals sign up for health coverage on the ACA exchanges. This year, only 39 organizations received grants for navigators to help individuals enroll in ACA plans, leaving many consumers on their own to navigate and complete the complex enrollment process.

This number is down significantly from last year and many are saying this is yet another attempt to weaken the ACA. ACA Navigators assist people with enrolling in health insurance coverage through the exchanges. One major concern with the lack of navigation surrounds newly implemented short-term, limited duration plans that skirt the ACA’s patient protections and coverage standards and are therefore known as “junk plans.”

Maryland, Advocacy Groups File Separate Suits to Protect ACA

A lawsuit filed by 20 attorneys general from conservative states to dismantle the ACA is awaiting a ruling in Texas. In response, Maryland Attorney General Brian Frosh filed a lawsuit yesterday “seeking a declaratory judgment in U.S. District Court of Maryland that the ACA is indeed constitutional and the Trump administration must stop trying to ‘sabotage’ the Obama-era Affordable Care Act.”

And just today, "a coalition of patient advocates and other healthcare groups is going to court to try to block the Trump administration from expanding the availability of short-term health plans that don’t offer a full set of benefits." 

It remains to be seen how any of these lawsuits move forward, but the politics of the ACA continue to play a central role eight years after it was passed.


CHART OF THE WEEK

High Prices, Broken Promises: What should be done about the high cost of prescription drugs?

NORC/West Health Issue Brief

A new poll from West Health, conducted by NORC at the University of Chicago, says that 77% of Americans say drug prices are “unreasonable,” and Americans rank health care costs among the most important issues. Read the full report »


IMPORTANT READS

Emergency Preparedness for Cancer Survivors

National Cancer Institute (NCI)

As hurricane Florence makes its way up the East Coast, the National Cancer Institute outlines resources that are helpful in preparing cancer patients in the face of catastrophic events. Resources include tips for patients and caregivers on developing a plan in case of an emergency and information on how to link patients with their doctors during a natural disaster.

For more information, call the NCI help center: 

1-800-4-CANCER (1-800-422-6237)

Read More »

Are We Being Misled About Precision Medicine?

New York Times Op-Ed

In a New York Times op-ed, health reporter Liz Szabo explores how uncritical media coverage of individual successes in precision medicine—in contrast with studies showing extremely high failure rates—creates false hope for those with advanced cancer.

At the most recent meeting of the American Society of Clinical Oncology, researchers presented four precision-medicine studies. Two were total failures. The others weren’t much better, failing to shrink tumors 92 percent and 95 percent of the time. The studies received almost no news coverage.

Many of the doctors I interview as a health care reporter are uncomfortable talking about patients who don’t survive. They pivot to talking about people they’ve saved. They rush past the disappointing present and fast-forward to a future in which every patient gets the treatment she or he needs. If you don’t listen carefully, you could easily be led to believe those future cures are already here.

Read More »

Unwitting Patients, Copycat Comments Play Hidden Role in Federal Rule-Making

Via Kaiser Health News

Submitting comments and letters to federal agencies is an important civic duty that allows citizens to weigh in on federal rules and regulations.

Hundreds of comments were submitted to the Centers for Medicare and Medicaid Services by patients and organizations regarding the 340B program, a drug discount program that many hospitals rely on to provide certain drugs and services. Kaiser Health News reviewed those responses and made the startling discovery that some individuals were not aware their names were used to submit comments opposing the 340B program. This is a concerning development, which will almost certainly result in additional scrutiny.

Read More »

More than 4,300 Arkansas residents lose Medicaid under work requirements

Via Washington Post

Back in June, Arkansas imposed work requirements for Medicaid beneficiaries in the state. This week, Governor Hutchinson announced that 4,353 people were dropped from receiving health care through Medicaid due to the new work requirement policy.

Kevin De Liban, an attorney for Legal Aid of Arkansas, said that 90% of individuals enrolled in Arkansas Medicaid expansion are actively employed or have qualified for an exemption. He said those losing their health care because of this new policy are being hurt primarily because of “administrative hoops that trip people up.” It should be noted that the website used for people to submit their information closes each night from 9:00pm until 7:00am.

Read More »


Related Posts

Health Care Roundup: Texas Court Hears ACA Lawsuit; House, Senate Advance Pharmacy “Gag Clause” Bans; Long-Distance Caregiving; and More

Health Care Roundup: Kasich on Medicaid Expansion Success; New Cervical Cancer Screening Choices; a Nurse’s ‘Gut Feeling’; and More

In order to bring you the latest cancer-related health care policy and news, we at NCCS combined 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 content 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 »


HEALTH CARE HIGHLIGHTS

ACA Troubles in Texas Lawsuit

A lawsuit filed by 20 attorneys general from conservative leaning states saw its day in court this week. Earlier this summer, these attorneys general brought forth a lawsuit claiming that the Affordable Care Act (ACA) is unconstitutional because the individual mandate was repealed by Congress last year.  With the Trump administration taking the very unusual step of declining to protect a federal law passed by Congress, several democratic attorneys general stepped in to argue that repealing the individual mandate does not invalidate the entire law.

Oral arguments were heard Wednesday by Judge Reed O’Connor, who sounded openly opposed to the ACA. The Judge’s questioning gave the impression that he is skeptical of the ACA’s standing without the individual mandate. He gave no indication of when he will make a decision, but either way, there will almost certainly be an appeal and the case could go all the way to the Supreme Court.

Meanwhile, confirmation hearings for Supreme Court nominee, Judge Brett Kavanaugh, are underway. Judge Kavanaugh has not provided any insights into his views on the ACA during the hearings, but if he is confirmed he could be a deciding factor on the future of the ACA.


CHART OF THE WEEK

The ACA’s Pre-Existing Condition Protections Remain Popular with the Public, including Republicans, As Legal Challenge Looms This Week

Kaiser Family Foundation


IMPORTANT READS

House Committee Advances Ban on “Gag Clauses” Saying It Will Reduce Drug Costs

Via Washington Examiner

The House Energy and Commerce’s Health Subcommittee today advanced a series of health care bills. The Washington Examiner notes:

One of the pieces of legislation is a draft bill that bans private insurers and drug middlemen called pharmacy benefit managers from inserting "gag clauses" into contracts with pharmacists. The clause prohibits the pharmacist from telling a consumer it is cheaper to pay for a drug out of pocket rather than through insurance.

It looks as though bipartisan support for such legislation is growing in Congress and could continue to move ahead. The Senate this week unanimously passed a similar 'gag clause' bill targeting Medicare Part D insurers. That bill now awaits action in the House.

Read More »

She’s worn both a hospital gown and a white coat. Now she wants to change how doctors perceive their patients

Via STAT News

This is the inspiring story of Shekinah Elmore. Two weeks after finishing treatment for her third stint with cancer, she began medical school. Based on her experiences as both a patient and a doctor, she’s trying to help change the doctor-patient relationship:

Elmore wanted her peers to recognize that not every person who looks well is well. Her classmates began to draw imaginary lines between themselves, the “healthy,” and their future patients, the “sick.” Elmore herself was proof that those categories aren’t so clear cut. Later, she’d realize how much their use hurts patients.

Read More »

Strategies for Long-Distance Caregiving

Via New York Times

A study called “Closer: A Videoconference Intervention for Distance Caregivers,” research funded by the National Institute of Nursing Research, aims to discern the extent to which using technologies can help distance caregivers connect with their loved ones in meaningful ways. This includes virtually attending visits to be a part of the treatment decision making process.

“Distance caregivers, compared to local caregivers, have higher stress, feel less support, have higher anxiety and more burden,” Dr. Douglas said. “It’s a group that hasn’t been well recognized. We haven’t really done a really good job up until this point in terms of trying to provide services that in some way make being a distance caregiver less stressful and more meaningful.”

Read More »


Related Posts

Health Care Roundup: Kasich on Medicaid Expansion Success; New Cervical Cancer Screening Choices; a Nurse’s ‘Gut Feeling’; and More

Health Care Roundup: ‘Junk Insurance;’ High Costs and Forgone Care; Reinsurance; Patient Safety After Hospital Mergers

US Capitol Building

Washington, DC – The National Coalition for Cancer Survivorship (NCCS) applauds the efforts of Senator Tammy Baldwin (D-WI) and 30 of her colleagues to advance a resolution blocking the final rule permitting expansion of short-term plans. The final rule extending the availability of short-term plans will put more Americans at risk of purchasing junk insurance plans and will also undermine the individual insurance markets on which many people with cancer rely.

“NCCS considers these new short-term plans a serious threat,” said NCCS CEO Shelley Fuld Nasso. “We are concerned that many individuals will be attracted to the lower premium costs of short-term plans only to find that the plans will not cover their care for a new cancer diagnosis. These plans may also pose a threat to cancer survivors who rely on the individual market for affordable and adequate insurance coverage. Individual plans may become more expensive and less comprehensive if healthy people abandon the individual market for short-term plans and the individual market is splintered.”

On August 1, 2018, the Departments of Health and Human Services (HHS) and Treasury finalized a regulation that would permit insurers to offer so-called short-term insurance plans for as long as 36 months, instead of 12 months previously. Insurers offering these plans could refuse to cover those with pre-existing conditions and could charge consumers more for their insurance coverage on the basis of their health status. These plans are also called junk plans because they do not have to offer specified benefits, including prescription drug coverage.

NCCS commends Senator Baldwin and her colleagues for pursuing efforts to protect people with pre-existing conditions. We continue to oppose efforts to undermine the protections of the Affordable Care Act, which have been critically important to cancer patients and cancer survivors in the individual insurance market. Without ACA protections, cancer survivors—who have a pre-existing condition from the time of diagnosis—may be unable to purchase affordable and adequate insurance.

# # #

Related Posts

NCCS Statement on HHS Final Rule for Short-Term, Limited Duration Health Plans

Health Care Roundup: DoJ Decision Not to Defend ACA Puts Patient Protections At Risk; “Cancer Treatment Beyond Mutant-Hunting”


Read more NCCS Policy Comments »

In order to bring you the latest cancer-related health care policy and news, we at NCCS combined 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 content 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 »


HEALTH CARE HIGHLIGHTS

Court Throws Out KY Governor’s Medicaid Countersuit

Kentucky Governor Matt Bevin (R) lost a lawsuit against Medicaid recipients who are challenging the Governor’s attempt to implement Medicaid work requirements. Earlier this year, Bevin was also unsuccessful in moving forward with his plans in changing components of Medicaid expansion in the state when a federal court sided with the same Medicaid recipients.

The ruling in this most recent dismissal against Bevin pointed out that the countersuit “did not address the substance of the case.” It should be noted again that if Bevin is eventually successful in implementing his plan to alter Medicaid expansion in Kentucky, 95,000 Kentuckians would no longer be covered under his proposal.

Gov. Kasich Continues to Spotlight Successes of Ohio's Medicaid Expansion Successes

Offering a different perspective is Ohio Governor John Kasich (R), who continues to support Medicaid expansion under the Affordable Care Act (ACA). In a state government report released earlier this week, Kasich pointed out the benefits of the ACA, including the fact that the uninsured rate was cut in half. The report also stated that Medicaid expansion reduced the number of times enrollees used ER services, while increasing utilization under primary care.

Enrollees were also able to access treatment for hard-to-treat conditions, making it easier for those beneficiaries to seek out work while on Medicaid. The program also improved the outcomes in opioid addiction and poor mental health, reporting that 96 percent of those struggling with opioid addiction received treatment. With the future of the ACA uncertain under the Trump administration, Governor Kasich hopes to continue to shed light on the fact that Medicaid has improved health care for thousands of Ohioans.

Plans on Drug Pricing Still Remain Unclear

The Trump’s administration handling of drug pricing costs continues to leave some key players frustrated with few signs of the next steps to making drugs affordable for Americans. Several drug companies remain cautious in accepting the policy changes the administration may propose soon, while other companies continue to operate business as usual. For U.S. Health Secretary Alex Azar, the focus on drug pricing is still on getting rid of drug rebate programs. Pharmaceutical benefit manager (PBM) groups are fighting against Azar’s plans, pointing out that HHS would need Congressional approval before eliminating the drug rebate program. PBMs were established to negotiate reduced costs of medicines, though their effectiveness has been questioned.

The Trump administration feels increased pressure to establish more definitive stances on drug pricing as mid-term elections approach.

Now, More Choices for Cervical Cancer Screening

The US Preventive Services Task Force (USPSTF) announced that women between the ages of 30 to 65 have more options when it comes to checking for cervical cancer. Women may now receive an HPV test, a Pap test, or both.

Cervical cancer screening and Pap smears have been key in greatly reducing deaths from cervical cancer from 2.8 to 2.3 deaths per 100,000 women between 2000 and 2015. Previously, the task force had only recommended women get either the Pap smear or the HPV test.

The task force also recommends women test regularly:

  • For women ages 21 to 29 — Pap smear screening once every three years;
  • For women ages 30 to 65 —
    • Pap smear screening once every three years, or;
    • HPV test once every five years, or;
    • Both tests taken once every five years.

The task force says women over the age of 65 no longer need cervical screening, if they were adequately screened prior to turning 65.


CHART OF THE WEEK

What Does Knee Surgery Cost? Few Know, and That’s a Problem

Wall Street Journal


IMPORTANT READS

Racial Disparities, Prescription Medications, and Promoting Equity

Via Public Health Post

In a viewpoint article at the Public Health Post, two authors lay out racial disparities in access to drug treatment is not just a matter of socioeconomic level. Race and ethnicity is a strong predictor of how frequent medication is used (or underused), the likelihood of being insured, and discrimination in prescribing practice.  Solutions that are provided include encouraging Medicaid expansion and ACA, reduce discrimination in prescribing, and to continue to shift to value-based formularies to lower costs. Read More »

Shared decision-making isn’t all that shared—“Should You Get That Scan? Your Doctor Might Not Be Great At Helping You Decide”

Via National Public Radio (NPR)

A study published in JAMA Internal Medicine looked at how well doctors talked about the risks and benefits of lung cancer screening. The results showed that when it comes to explaining the ways that certain screenings can cause you harm, doctors could use some help. The study evaluated conversations between doctors and patients as part of JAMA’s “Less is More” research on the costs of too much treatment and testing. "It's about a deeper issue: … Is healthcare structured to give patients the information they need to make informed decisions?" says Dr. Daniel Reuland, a professor of medicine at the University of North Carolina–Chapel Hill. Read More »

How to Quantify a Nurse’s ‘Gut Feelings’ (Opinion)

Via New York Times

Nurses often have “gut feelings,” but actually these feelings are more of agglomerations of observations and experiences that they have honed over time and what the author says has turned into “finely tuned clinical judgement.”

Read More »


Related Posts

Health Care Roundup: ‘Junk Insurance;’ High Costs and Forgone Care; Reinsurance; Patient Safety After Hospital Mergers

Health Care Roundup: “Toxic Town” in WV Battles High Cancer Rates; CMS News: Risk Adjustment, 340b, Site-Neutral Payments; Hospital Costs; More

In order to bring you the latest cancer-related health care policy and news, we at NCCS combined 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 content 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 »


HEALTH CARE HIGHLIGHTS

Trump Admin Continues Push to Make Short-Term Health Plans More Acceptable

On Wednesday, the Trump administration made it easier for short-term plans to reach more consumers in another move to try to halt further ACA progress. While short-term plans are inexpensive, they do not cover pre-existing conditions and the range for medical services is much more limited. Opponents fear that this newly issued rule will further destabilize the market, making it harder for sicker individuals to receive the quality and timely care they need.

In a HHS press release, Secretary Alex Azar noted:

These plans aren’t for everyone, but they can provide a much more affordable option for millions of the forgotten men and women left out by the current system.

Simply stated, these plans are cheaper because they are “junk insurance.” Opponents to the finalized rules have stated they will continue to fight against these changes and to ensure that marketplaces will remain stabilized.

NCCS said in a statement regarding the final rule:

NCCS is concerned that individuals will buy short-term plans thinking they are getting a good deal until the moment they need health care services, or worse, face a diagnosis of cancer, when they will be stuck with enormous out-of-pocket costs. These plans are NOT a substitute for the comprehensive health coverage that the ACA ensures. By expanding and promoting short-term limited-duration plans, the administration is taking patients back to the days when insurance companies denied individuals who are sick and excluded coverage for the care that cancer survivors need.

Read the full NCCS statement on the rule »

CMS Approves Two State Reinsurance Programs

Reinsurance programs have been introduced as a way to help stabilize the ACA’s individual markets. Earlier this week, the Centers for Medicare and Medicaid Services (CMS) approved Wisconsin’s and Maine’s decision to move forward with the next steps for creating reinsurance programs. Alaska was the first state to apply for approval to establish a reinsurance program for the state in 2017. Several other states have already been approved and a few other states who have applied are waiting for approval.

In a letter to Gov. Scott Walker for adopting the program, CMS wrote, "[The] reinsurance program will lower individual market premiums in the state and the premium tax credits (PTC) to which Wisconsin residents would have been entitled absent the waiver."

While the reinsurance programs are not a long-term solution to the issues facing the ACA, more states will continue to create these programs as a simple fix in the short-term.


IMPORTANT READS

Shopping for Health Care Simply Doesn’t Work. So What Might?

Via New York Times

Austin Frakt, director of the Partnered Evidence-Based Policy Resource Center at the V.A. Boston Healthcare System, goes into depth about the inadequacies of health care shopping. He points to multiple bodies of research that indicate people do not know how to properly shop for care, unintentionally turning down necessary care when attempting to cut out excessive care. Complexity of navigating the system and lack of time in searching for the right care are also factors in why health care shopping is not wholly effective. Frakt proposes several options, including how to utilize physicians to better inform patients.

Read More »

Missed Visits, Uncontrolled Pain And Fraud: Report Says Hospice Lacks Oversight

Via Kaiser Health News

A newly released report from the Office of Inspector General (OIG) at HHS reveals oversight issues in hospices. The report highlights the troubling trend of poor hospice care, most notably instances of elderly patients left in unbearable pain or respiratory distress, untimely and inadequate care, and persistent fraud.

The report urged CMS to take action, recommending 15 action steps. However, CMS Administrator Seema Verma objected to eight of the actions steps proposed by the OIG but approved of six recommendations. It is especially important to find solutions to these ongoing hospice care problems since the aging population of the U.S. will rely more and more on hospice care.

Read More »

Hospital mergers or acquisitions may cause short-term patient safety issues

Via STAT News

In an opinion piece on STAT news, three authors make the case for why mergers do more harm than good. In their study, they propose that mergers do not ensure better patients care, but in fact increases the risk of harm. Three key sources of risk are identified: new patient populations, unfamiliar infrastructure, and new settings for physicians. While acknowledging that mergers and acquisitions will continue to speed up, the researchers also emphasized throughout the article the necessity of clinical experience and input in evaluating risks to patients in the health system merger planning process.

Read More »


Related Posts

NCCS Statement on HHS Final Rule for Short-Term, Limited Duration Health Plans

Health Care Roundup: “Toxic Town” in WV Battles High Cancer Rates; CMS News: Risk Adjustment, 340b, Site-Neutral Payments; Hospital Costs; More

In order to bring you the latest cancer-related health care policy and news, we at NCCS combined 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 content 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 »


HEALTH CARE HIGHLIGHTS

CMS Resumes ACA Risk Adjustment Payments

The Centers for Medicare and Medicaid Services (CMS) announced it will continue payments—amounting to $10.4 billion—to the Affordable Care Act’s (ACA) risk-adjustment program. The program was established to ensure that risk is spread across insurance companies.

Recently, in one of the many efforts to dismantle the ACA, CMS announced that it would halt the payments, highlighting concerns about the risk-adjustment formula from a federal judge’s ruling in New Mexico.

Insurers responded to CMS’ move by warning about the possibility of raising next year’s ACA premiums due to unpredictability of risk adjustment payments. In a statement regarding the decision to allow payments to be made to insurers again, CMS Administrator Seema Verma said:

Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today. Alleviating concerns in the market helps to protect consumer choices.
– CMS Administrator Seema Verma

Additional Cuts Proposed to 340B Drug Program

CMS is seeking to make further cuts to 340B drugs at hospital off-campus sites in a proposed rule released on Wednesday. The 340B program allows hospitals to buy certain drugs at a lower cost. CMS is now proposing to make additional cuts to 340B hospitals by extending these cuts to an even greater number of off-campus hospitals and outpatient clinics. This proposal could harm patients’ access to care, especially for vulnerable populations who rely on 340B hospitals for their care.

In 2018, CMS implemented a payment policy to help beneficiaries save on coinsurance on drugs that were administered at hospital outpatient departments and that were acquired through the 340B program—a program that allows hospitals to buy certain outpatient drugs at a lower cost.

Due to CMS’s policy change, Medicare beneficiaries are now benefiting from the discounts that 340B hospitals enjoy when they receive 340B-acquired drugs. In 2018 alone, beneficiaries are saving an estimated $320 million on out-of-pocket payments for these drugs. For 2019, CMS is expanding this policy by proposing to extend the 340B payment change to non-excepted off-campus departments of hospitals that are paid under the Physician Fee Schedule.

Hospitals that take part in the 340B program will undoubtedly push back aggressively on this proposed rule. The Association of American Medical Colleges responded, “CMS' proposal to cut Medicare payments to existing outpatient departments for clinic services runs counter to Congressional intent and would seriously damage the ability of the nation's teaching hospitals to serve the most complex and vulnerable patients.”

CMS Seeks Site-Neutral Payment Policies

In another move that is adding further frustration for hospital groups, CMS announced they intend to adopt site-neutral payment policies.

As an Inside Health Policy article explains it:

The proposed rule would establish a payment rate for hospital outpatient clinic visits equivalent to what those services would be paid under Medicare's physician fee schedule–which would amount to 40 percent of what CMS currently pays under the Outpatient Prospective Payment System.

The article went on to say:

CMS Administrator Seema Verma said on a call with reporters that she wants to end Medicare policies that pay different rates for similar services based on the type of site where the services are provided.

“This would put all providers on a level playing field, so CMS is not tipping the scales toward one site of care,” Verma said.

If finalized, the change would result in a significant reduction in payments to hospitals. We will continue to monitor these changes as they may impact patients’ access to care.


CHART OF THE WEEK

Think drug costs are bad? Try hospital prices

Bob Herman, Axios.com

Per capita health expenditures, 2000 – 2016.
Data: Centers for Medicare & Medicaid Services
Chart by Kerrie Vila, Axios


IMPORTANT READS

Gender Equity in Health Care Still Has a Way to Go

Via HealthCareDive.com

This brief highlights the concerns many female health care professionals still face when it comes to gender parity. While many are happy to see the shift towards a more gender equitable workplace still ongoing, more and more women continue to speak out on issues relating to sexual harassment and the wage gap, as well as, racial discrimination for women of color.

Read More »

A toxic town, a search for answers

Via Washington Post

Cancer clusters remain a frightening environmental and public health concern for all Americans. Physician Ayne Amjad is one of the many who have been deeply affected by her town’s history of mismanaging toxic waste that led to the “illnesses plaguing [the] town.”

This report delves into the history of industrial chemical dumping in Milden, West Virginia, the community’s overwhelming cancer rates and deaths, and Amjad’s search to connect the two. Following the footsteps of her physician father, who passed away from cancer himself, Amjad remains dedicated to carry on his work in not only learning more about the link, but to bring justice to the people who will continue to struggle under the burden of cancer for years to come.

Read More »

Want healthier communities? Address social factors

Via Public Health Newswire

The “social determinants of health” continue to pave the way for how we look at and address community and population health, shared Ceci Connolly, CEO of Alliance of Community Health Plans, as she discussed the importance of improving the incorporation of social determinants into community health plans.

Connolly outlines how these health plans can better serve beneficiaries, providing examples such as “treat the whole person”, “meet people where they are”, “speak their language”, and “address economic and housing insecurity.” These social determinants must get more attention, as the article points out that “public health professionals are well aware that 75 percent of the factors affecting our health are believed to be non-medical, such as homelessness, hunger and lack of transportation.”

Read More »

Hospital’s experiment in sedating patients without consent raises ethical concerns

Via Washington Post

Hennepin Healthcare System in Minnesota faces mounting scrutiny and anger for their practice of sedating patients without consent, then using results for research. Patients with agitation who were taken by ambulance were given powerful drugs without their consent and were later informed by Hennepin that they were subjects in a study that compared the effectiveness of different sedatives-most notably ketamine- on patient agitation. Hennepin responded to inquiries about their practices, emphasizing the hospital system’s dedication to transparency and “integrity of scientific research.”

Read More »


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