Oncology Leaders Praise Health Law Ruling-With Caveats

Leaders in the oncology care and research communities largely applauded the US Supreme Court ruling Thursday that upholds the Affordable Care Act (ACA), mixing their optimism with a measure of caution over the impact of the contentious healthcare legislation on clinical practice.

Organizations dedicated to fighting cancer, including the American Society of Clinical Oncology (ASCO) and the American Cancer Society, called the decision a positive development for healthcare providers, researchers, and patients, despite concerns about the ramifications of continued political battling over the law.

ASCO President Sandra M. Swain, MD, medical director of the Washington Cancer Institute at MedStar Washington Hospital Center, said in a statement that the ACA offers a number of provisions that protect those who have cancer or are at risk for cancer.

These include free preventive screenings, the elimination of lifetime limits within health insurance plans, the opportunity for people to get private health insurance regardless of pre-existing conditions, and coverage for participation in clinical trials.

Earlier this year, ASCO said that the ACA had the potential to help reduce racial and economic disparities in cancer care.

“Although the Supreme Court's recent decision largely upheld the ACA, the national policy debate will continue over how to shape our healthcare system and provide Americans with access to health insurance in the future,” Swain said. “We urge Congress and other policy makers to recognize and protect the safeguards that are especially important to Americans who are facing life-threatening forms of cancer.”

Maurie Markman, MD, senior vice president for Clinical Affairs and national director for Medical Oncology at Cancer Treatment Centers of America in Philadelphia, believes that the law will have a positive impact but that there are still questions about how the ACA will accommodate the continued rapid advancement of cancer research while controlling costs and providing care for more patients.

“I’m cautiously optimistic, but only as long as the discussion continues,” said Markman, who is editor-in-chief of OncologyLive magazine. “We have to constantly put patients in the forefront, improving their duration and quality of life. The worst would be to develop a bureaucracy that will prevent treatments from changing, but I know that won’t happen—Americans won’t allow it.”

Andrew L. Pecora, MD, chief innovations officer and vice president of Cancer Services at John Theurer Cancer Center at Hackensack University Medical Center in New Jersey, also had a mixed view.

“It will be good all the way around to have people who don’t have access to insurance get that access. It will increase access to life-extending and life-saving therapies,” said Pecora, who is editor-in-chief of Oncology and Biotech News. “The concern is that it’s not clear how we’re going to avoid falling into the trap that has occurred in Great Britain, where at the end of the day you have rationing of cancer therapies by small groups deciding based on economics whether someone should have access to something that’s proven to be of benefit.”

Moy et al discussed the anticipated effects of the ACA on the oncology community in an article that appeared in the 2012 Educational Book that ASCO published in June at its annual meeting.

Their concerns about the law include a decrease in oncology provider participation in Medicaid as reimbursement levels drop; continued poor cancer outcomes among Medicaid patients; and the lack of a mandate for insurers to cover follow-up testing of abnormalities found in cancer screenings.

At the same time, the ACA holds promise, the authors wrote, because it will help close the Medicare “donut hole” gap in prescription drug coverage, important for those taking expensive oral cancer therapies; it will no longer require children who want hospice services to forgo curative services; it gives patients the right to a timely external appeal of coverage decisions; and it prevents insurers from denying coverage for clinical trial costs, which could ultimately increase minority participation in trials.

The American Association for Cancer Research also sees positives in the ACA.

According to the organization’s website, the law calls for the establishment of the Patient Centered Outcomes Research Institute to compare the clinical effectiveness of treatments, which will help researchers focus on valuable therapies; grants to help speed the translation of basic scientific discoveries into treatments; and $15 billion over 10 years committed to cancer prevention.

Congress enacted the ACA in 2010 with the aim of increasing the number of Americans covered by health insurance and decreasing the cost of healthcare. Its constitutionality was challenged by 26 states, several individuals, and the National Federation of Independent Business, who argued that it was a costly, unconstitutional usurpation of individual rights.

In its 5-4 decision, the Supreme Court upheld the central tenet of the act: that individuals be required to buy their own health insurance if they are not insured by an employer or government program, and are not otherwise exempt from the rule.

Starting in 2014, the penalty for not complying will be a “shared responsibility payment” to the federal government; the court majority said they regarded that payment as a tax that Congress has the power to levy.

But the court struck down another core provision of the act, making it optional. That provision would have required states to accept additional federal funding and expand their Medicaid programs to cover the healthcare needs of adults with incomes up to 133% of the federal poverty level.

The court deemed the provision unconstitutional because states that did not comply would have faced the loss of all their federal Medicaid funding, amounting to a denial of their right to choose whether to accept grant funding and conditions for its use.

John R. Seffrin, PhD, chief executive officer of the American Cancer Society, praised the court’s decision.

“The ruling is a victory for people with cancer and their families nationwide, who for decades have been denied health coverage, charged far more than they can afford for life-saving care and forced to spend their life savings on necessary treatment, simply because they have a pre-existing condition,” he said.