If the Affordable Care Act (ACA) is repealed, the number of people who are uninsured by 2026 will increase to 32 million relative to current law, according to the official nonpartisan Congressional Budget Office.1
Even for those who remain insured, the costs of care—including premiums, deductibles, and out-of-pocket costs—could go up. Cancer treatments and screenings could become unaffordable. As health care professionals, what is our role in the changing insurance climate? More importantly, how do we navigate and advocate for our cancer patients with restrictions to health care or rising copayments that lead to financial toxicity?
Pros of the ACA:
- Provisions of the law make care accessible to those who had previously been shut out. The uninsured rate has dropped by 5% since the program began
- Children can stay on their parent's health care plan until age 26
- No one can be denied insurance for a pre-existing medical condition
- Companies can no longer charge women more than men
Some problems of the ACA include:
- Under the ACA, states
were supposed to expand the number of people who qualified for Medicaid, which
had been reserved for the poor, and in return the federal government would provide
the states more funding. Budgetary controversies persist on how much federal funding
should be allotted to the states
- Insurance companies are backing out of participating
in the ACA because fewer Americans than anticipated are signing up; that, in turn,
raises insurance costs for everyone. In some areas, there is only one insurer
willing to take on patients in the marketplace
- Premiums are expected to rise by
an average of 25% this year. This increase was
predicted at the start of the law,
and government subsidies that help pay for insurance will also increase; however,
those who should be covered by the Medicaid expansion aren't eligible for those
subsidies. Some states have declined Medicaid funding, thus leaving their most
vulnerable citizens without assistance to the cost of copayments.
All aspects of the media have covered the law and its implementation more thoroughly than perhaps any other law in recent American history. But according to several national polls conducted by reputable polling organizations, only 18% of Americans say they know enough about what is in the ACA.2
Cancer treatment leaves many of my patients in bankruptcy and it is not uncommon for me to contact private practices, HMO clinics, and hospitals to advocate for discounts for cash payments, writing off a portion of the total or setting up reasonable payment plans that patients can manage.
Finally, I believe it is imperative to appreciate the needs of the community in which we practice.3 As part of our cancer center accreditation, we are required to submit a triennial community needs assessment in which we note the health necessities of our citizens, as well as the barriers and inequities in health care. And we must demonstrate how we are going to address these needs. Further Congressional discussions will take place this summer. I am not taking issue with either side in the debate; I only want to point out that our cancer patients will be caught up in the decisions that are made.
Has anyone from any other state (I am in California) experienced difficulties with health care inequity? How have you decided to address these issues as a private citizen and as a healthcare professional?
1. Congressional Budget Office. H.R. 1628, Obamacare Repeal Reconciliation Act of 2017. https://www.cbo.gov/publication/52939.
2. Blumberg LJ, Holahan J. Early experience with the ACA: coverage gains, pooling of risk, and medicaid expansion. J Law Med Ethics. 2016; 44:538-45.
3. Bias TK, Abildso CG, Vasile E, Coffman J. The impact of community input in community health needs assessments. J Public Health Manag Pract. 2017;23 Suppl 4 Supplement, Community Health Status Assessment:S29-S33.