Health Reform: Illusion, Delusion or Reality
Q: How likely are the provisions you’ve outlined today to survive in the new Congress?
American Cancer Society Cancer Action Network: We’re optimistic that the strong patient provisions will survive. The majority in the Senate and the president—who has committed to vetoing any repeal attempts—are the same as when the law passed.
Q: How will what has been done to date in health care reform help get more consistent Medicare coverage for ovarian cancer treatment? In particular, will it help in the discrepancy between TX, NM, CO, and OK’s lack of coverage for bevacizumab (Avastin) where for the rest of the country it is covered?
American Cancer Society Cancer Action Network: There is nothing in the health care reform bill that would remedy the differences across states in Medicare coverage decisions. Most coverage decisions are made administratively by the local Medicare contractors that operate in each state. The Center for Medicare and Medicaid Services is moving towards a more centralized coverage decision process, but that’s taking time to implement.
Q: Currently what is being done for pre-existing conditions in girls who were diagnosed with cancer at an early age, but are now older than 18 and need to get individual coverage?
American Cancer Society Cancer Action Network: There are a couple of provisions in the law that have already taken effect that will benefit women who were diagnosed with cancer at a young age. One is dependent coverage availability up to age 26. Another provision created high risk pools or pre-existing condition insurance plans that offer insurance to those who have been uninsured for six months or more and who have been denied insurance already in the individual market. By 2014, insurance companies will no longer be able to discriminate based on health status or health history.
Q: Will this law cover those who would like to participate in or need to be on a clinical trial?
American Cancer Society Cancer Action Network: The law requires all commercial health insurance plans offering group or individual coverage, health plans offered through the Federal Employee Health Benefit Program (FEHBP), employer-sponsored plans that self insure and operate under ERISA, and state self-insured plans to pay for the routine patient care costs associated with participation in high-quality clinical trials(phases I to IV) for cancer or another life-threatening disease or condition. Coverage extends to clinical trials conducted outside the state in which the patient resides. It does not require coverage for out-of-network services unless those benefits are otherwise provided under the plan. The clinical trials provisions do not apply to “grandfathered” plans, however.
Ovarian Cancer National Alliance: One provision of the health reform bill requires coverage of the routine costs of care associated with the trial, and cannot deny the patient access to the trial. This only applies to approved clinical trials, which includes any NIH or NCI sponsored trials.
Q: Will the changes increase or decrease entry into trial protocols? Often were chosen in current environment because of the reduction in out-of-pocket costs.
American Cancer Society Cancer Action Network: It’s hard to say how entry into trials will be impacted at this point. We’re hopeful that coverage of routine costs and extended coverage for out-of-state trials will help to reduce some of the previous barriers to enrollment that existed.
Q: Will the Affordable Care Act cover screening for ovarian cancer in women who are at high risk? Right now women without insurance cannot get this screening and need it.
American Cancer Society Cancer Action Network: Right now the law requires coverage of services that have an “A” or “B” rating by the United States Preventive Services Task Force, which in large part focuses on average-risk populations. However, the development of the essential benefits package may be an additional area where testing for women at high risk may be covered.
Ovarian Cancer National Alliance: Currently, most insurance companies cover testing protocols for women who are at high risk of developing ovarian cancer. There is no medically accepted screening test for ovarian cancer.
Q: If I have BRCA test and have the gene and my daughter gets tested and also has the gene, can the insurance company discriminate and drop her? Will she not be able to be covered?
American Cancer Society Cancer Action Network: The law will ban discrimination based on pre-existing conditions and medical history by 2014 in all plans.
Ovarian Cancer National Alliance: Additionally, the Genetic Information Nondiscrimination Act (GINA) prohibits insurers or employers from using genetic information. This law was enacted in 2008.