The Patient Protection and Affordable Care Act of 2010 (ACA), commonly called “Obamacare,” is currently approaching full implementation. As of January 1, the Health Insurance Marketplace will provide coverage to those who do not have it provided by their employers. Two years ago the American Society of Clinical Oncology (ASCO) assembled a team to assess the implications of the ACA and craft an official policy statement for the organization. Led by Dr. Beverly Moy, Clinical Director of the Breast Oncology Program at Massachusetts General Hospital, the statement notes several challenges within the ACA specifically with regard to cancer care. The expansion of Medicaid in particular was pointed out as having limited applicability to cancer patients, creating potentially poorer standards-of-care for those who participate in the system, and resulting in suboptimal reimbursement across the board. In addition, ASCO statement noted that the ACA preferentially benefits community health centers while disadvantaging the specialty treatment centers which have now become standard for cancer therapy. In addition, the ASCO statement suggests that Medicaid patients may not be able to participate in clinical trials.
Opinions vary regarding the overall positivity or negativity of the ACA with regard to cancer care. Forbes contributor Scott Gottlieb suggested that the ACA will restrict patients’ access to specialist physicians, including oncologists. He predicted that insurance providers may mitigate costs from cancer patients by limiting their access to in-network providers, effectively forcing them to pay out-of-pocket for the bulk of their care. However, the President of the ASCO, Dr. Clifford Hudis, recently noted in an interview with Reuters that he felt the implementation of the ACA would be a net benefit for his patients, and would especially improve the situation for cancer patients who have had difficulties securing coverage for long-term treatment of their disease.
Dr. Robert Figlin, of the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, has expressed a more skeptical view of the ACA with regard to cancer care. In a discussion with CadenceTalk, he noted that the ACA will likely improve treatment of common diseases like hypertension, diabetes, and pneumonia. However, he agreed with Gottlieb that access to oncology specialists would be limited. In addition, he noted that since much of the clinical research in cancer is driven by expert physicians, patients covered by ACA plans are not likely to have access to the latest experimental treatment options, and thus will not have access to the optimal care for their disease. Furthermore, Dr. Figlin observed that the number of available oncologists for patients with insurance coverage prior to the activation of the ACA was already too low, and adding more patients into the coverage pool will likely strain available resources for the whole country.
It will yet remain to be seen whether the increased availability of cancer care will offset any potential limitations in the quality of care, though oncologists all over the country are keenly anticipating the outcome as ACA coverage begins next year.