AACR Urges Protections for Americans with Cancer
Last week, Senate Republican leaders decided against voting on the Graham-Cassidy health care legislation, a bill that would have dramatically diminished several of the key provisions that are currently part of the Affordable Care Act (ACA).
For the past two years at its Annual Meeting, the American Association for Cancer Research (AACR) has facilitated special sessions to consider the reliance of cancer patients and cancer survivors on the expanded health insurance benefits and key protections of the ACA.
What we’ve learned from these sessions is that cancer patients and their families are especially affected by many key provisions of the ACA. For example, the 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. Therefore, any revision to the ACA should maintain these vital provisions.
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 anticancer medications, which would warrant denial of insurance for anyone who was taking them or who had taken them in the past. 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, about
1.5 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 for coverage. 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 were to be 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 revision or replacement to the ACA should maintain affordable access to these preventive services.
Finally, our healthcare system must support patient enrollment in clinical trials to bring the benefits of our nation’s investment in research to patients in need; 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.
The AACR, as the world’s first and largest organization dedicated to cancer science, stands ready to
work with Congress in a nonpartisan (or ideally, bipartisan) manner on behalf of cancer patients, families, and
survivors to ensure that vital provisions covering cancer
detection, diagnosis, treatment, and
survivorship are included in any future effort to replace or revise the ACA because access to comprehensive health insurance is important to all Americans, especially to the
1.7 million who will be diagnosed with cancer in 2017.
Gilbert S. Omenn, M.D., Ph.D., is chair of the
American Association for Cancer Research’s
Health Policy Subcommittee,
and the Harold T. Shapiro Distinguished University Professor of
Internal Medicine, Human Genetics, and Public Health at the University
of Michigan. Omenn
chaired sessions on the impact of the ACA on cancer patients at the AACR’s
Annual Meeting for the past two years.
Michael A. Caligiuri, M.D., is the president of the
American Association for Cancer Research. Caligiuri is also the director of The Ohio State University Comprehensive Cancer Center, and chief executive officer of the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
George D. Demetri, M.D., is the chair of the
American Association for Cancer Research’s
Science Policy and Government Affairs Committee and a member of the AACR board of birectors. He is also a professor of medicine at the Dana-Farber Cancer Institute and Harvard Medical School, and the co-director of the Ludwig Center at Harvard.