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WCOE: Graham-Cassidy Repeal Plan Has Deep Cuts; Bipartisan ACA Hearings Set; Sticker Shock Over Leukemia Drug; New Palliative Care Study; & More

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What Caught Our Eye (WCOE), August 25, 2017
What Caught Our Eye is our week-in-review blog series, where we recap the cancer policy articles, studies, and stories that caught our attention.

Affordable Care Act

“Cassidy-Graham Would Deeply Cut and Drastically Redistribute Health Coverage Funding Among States”

Via Center on Budget and Policy Priorities (CBPP) — The Cassidy-Graham plan (which Senator Dean Heller has also co-sponsored) would have much the same damaging consequences as other Senate and House Republican repeal and replace bills. It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, increase out-of-pocket costs for individual market consumers, and weaken or eliminate protections for people with pre-existing conditions.
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“Five governors to testify at hearing on bipartisan healthcare bill”

Via The Hill — Five governors will testify in front of the Senate Health Committee next month on ways to fix ObamaCare. Govs. Charlie Baker (R-Mass.), Steve Bullock (D-Mont.), Bill Haslam (R-Tenn.), Gary Herbert (R-Utah) and John Hickenlooper (D-Colo.) will testify at a hearing on Sept. 7.

Many insurers have requested large premium increases for 2018 because of the uncertainty surrounding the payments. The Trump administration has made them on a month-to-month basis, but insurers have asked for long-term certainty.
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“Data Note: Strongly Held Views on the ACA”

Via Kaiser Family Foundation — …Kaiser polls have shown an overall increase in ACA favorability over the past year, with 52 percent holding a favorable view of the law in August 2017, up 10 percentage points since June 2016, and nearly 20 percentage points since a low of 33 percent in November 2013.
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“Health reform revived: Murkowski says bills will advance via committee process”

Via the Fairbanks Daily News-Miner — Sen. Lisa Murkowski of Alaska said the health care discussion in Congress is moving forward nearly a month after the failed Republican attempt to repeal the Affordable Care Act.

“The committee process, which is something that I had been pounding the drum on for months and months, is underway,” Murkowski said at a Monday interview with the Daily News-Miner editorial board.

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“States Watch Iowa’s Push to Reshape Health Law”

Via Wall Street Journal — Officials seek waiver to revamp rules, including subsidies; Ohio, Oklahoma, others consider changes.

Iowa asked for federal permission to alter major provisions of the Affordable Care Act next year, a proposal that will be closely watched by officials in other states who hope to rewrite parts of the health law as Republican efforts to do so in Congress have stalled.
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Cancer News

“‘Breakthrough’ Leukemia Drug Also Portends ‘Quantum Leap’ In Cost”

Via Kaiser Health News — When doctors talk about a new leukemia drug from Novartis, they ooze enthusiasm, using words like “breakthrough,” “revolutionary” and “a watershed moment.” But when they think about how much the therapy is likely to cost, their tone turns alarmist.
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“Palliative Care Cut Healthcare Use in Advanced Cancer: Data show real-world influence in Medicare patients”

Via Medpage Today — In elderly patients with advanced cancer, a palliative care consultation soon after diagnosis substantially decreased healthcare use, and helped caregivers manage patients’ expectations, as well as maintain their quality of life (QoL), according to researchers.
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“Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference?”

Via the Commonwealth Fund — Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider.
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What Caught Our Eye: ‘Extremely High Premiums’ for the Sick, AHCA News, FDA Aims to Control Rx Pricing, & More

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What Caught Our Eye (WCOE), May 26, 2017
What Caught Our Eye is our week-in-review blog series, where we recap the cancer policy articles, studies, and stories that caught our attention.

In the Spotlight

“Millions Of Ill People May Face ‘Extremely High Premiums’ Under House Bill, CBO Says”

Via Kaiser Health News — The Republican overhaul of the federal health law passed by the House this month would result in slightly lower premiums and slightly fewer uninsured Americans than an earlier proposal. But it would leave as many as one-sixth of Americans living in states where older and sicker people might have to pay much more for their health care or be unable to purchase insurance at all, the Congressional Budget Office said Wednesday.
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Affordable Care Act

“Republican health care bill fails the Jimmy Kimmel test. Again.”

Via USA Today — Given our divisions, it’s often hard to imagine reaching a consensus in this country on anything. Yet polls show Americans are increasingly aligning behind the Kimmel test, in favor of universal and affordable coverage ensured by the government.
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“Three Strategies to Defend GOP Health Bill: Euphemisms, False Statements and Deleted Comments”

Via ProPublica — As Republican members of Congress seek to roll back the Affordable Care Act, commonly called Obamacare, and replace it with the American Health Care Act, they have adopted various strategies to influence and cope with public opinion, which polls show mostly opposes their plan. ProPublica, with our partners at Kaiser Health News, Stat and Vox, has been fact-checking members of Congress in this debate and we’ve found misstatements on both sides, though more by Republicans than Democrats. The Washington Post’s Fact Checker has similarly found misstatements by both sides.
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“Blue Cross Plan Puts 23% Obamacare Rate Hike On GOP Congress”

Via Forbes.com — “The biggest single reason for the sharp increase in rates is the lack of federal funding for cost-sharing reductions beginning in 2018,” North Carolina Blue Cross director of actuarial and pricing services Brian Tajlili wrote on the insurer’s web site Thursday.
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Cancer Policy

“Trump’s proposed budget would cripple the NIH and FDA”

Via Stat News — Ellen Sigal, founder of Friends of Cancer Research, writes:

“At best, the proposed budget suggests that the White House doesn’t understand how the NIH and the FDA function. At worst, it suggests a disregard for the millions of patients who are desperate for the scientific innovations, lifesaving therapies, and safeguards that emerge from these agencies.”
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“FDA Chief Proposes Rules Changes to Fight High Drug Prices”

Via Wall Street Journal — “Simply put, too many patients are priced out of the medicines they need,” [FDA Commissioner] Dr. [Scott] Gottlieb told a congressional subcommittee Thursday. “While the FDA does not have a direct role in drug pricing, we can take steps to facilitate entry of lower-cost alternatives to the market, and increase competition.”
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“In Bold Move, FDA Approves Cancer Drug For Any Advanced Tumor With Genetic Changes”

Via Forbes.com — The FDA’s accelerated approval of this drug might surprise traditional oncologists. It suggests the agency may be ditching an archaic system for classifying cancers based on body parts—like breast or liver or colon cancer—and instead will focus on molecular aspects of malignancies, qualities that render tumors vulnerable, or not, to targeted drugs.
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Coping with Cancer

“Counseling Improves Survivorship Plan Implementation for Low-Income Breast Cancer Survivors”

Via National Cancer Institute (NCI) — “The nurse counseling session was empowering [for the survivors], who were from a vulnerable population that is generally disempowered in their health care,” explained the study’s lead author, Rose Maly, M.D., of the UCLA Jonsson Comprehensive Cancer Center. The combination of a care plan and the counseling session, she continued, “set this up to be a powerful and impactful intervention,” she said.
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ACA Update | March 10, 2017: GOP Repeal Plan, the AHCA, Moves Forward in the House

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AHCA

Prior to the Affordable Care Act (ACA), cancer survivors were at the mercy of the health care system, often forced to pay exorbitant premiums or simply denied coverage altogether. Today, America’s 16 million cancer survivors benefit from the ACA’s patient protections that are critical to providing them with quality, affordable, and accessible health care coverage. NCCS is actively engaged in advocating to ensure this unprecedented access for cancer patients and providers continues.
The American Health Care Act (AHCA), the long-awaited Republican bill to repeal and replace the Affordable Care Act (ACA), was unveiled earlier this week. NCCS released a statement opposing the AHCA, explaining that this legislation would be devastating for older, sicker, and poorer Americans, let alone those facing a cancer diagnosis. By ending the ACA’s cost-sharing provisions and replacing ACA subsidies with tax credits based on age, not income, this bill would make coverage more expensive, if not completely out of reach, for many cancer survivors. Additionally, the legislation radically restructures the Medicaid program and shifts funding from the federal government to states.

The bill preserves two of the most popular provisions of the ACA, which allow children to stay on their parent’s plan until the age of 26, and forbids insurers from denying coverage for individuals with pre-existing conditions such as cancer. However, these protections are useless if individuals are unable to afford insurance.

The AHCA hurts older Americans the most by allowing insurance companies to charge up to five times as much for premiums as younger individuals. With more than 60% of cancer diagnoses occurring in older Americans and many cancer survivors depending on Medicaid, this bill leaves the most vulnerable populations without sufficient access to care.

Major medical and interest groups, including AARP, the American Medical Association (AMA), America’s Health Insurance Plans (AHIP) and the American Hospital Association (AHA), have publicly opposed or expressed serious concerns with the AHCA, citing that the bill would result in millions of Americans losing coverage and benefits. The bill still lacks a complete analysis by the Congressional Budget Office (CBO), but several analyses have already concluded that the AHCA would make health insurance less affordable. A report by the Center on Budget and Policy Priorities found that consumers’ costs would likely increase even more than tax credits would fall, since the House plan would probably cause individual market premiums to rise.

It’s not just large interest groups that are speaking out against the AHCA. Individuals across the U.S. are realizing that this replacement plan would undo much of the progress made by the ACA and force patients to carry the burden of the cost of health care. A New York Times article highlights the story of a woman named Martha from North Carolina who voted for Donald Trump because she believed his Administration would make health care more affordable. In an interview earlier this year, President Trump vowed the replacement plan would have “insurance for everybody,” but the AHCA is far from achieving that goal. Since the release of the replacement bill, Martha is growing increasingly nervous because the replacement plan would decrease her premium subsidy by more than $5,000 per year.

Despite the absence of a cost estimate for the AHCA by the CBO, the health care plan passed in two House committees Thursday and will now head to the House Budget Committee for consideration and mark-up. The bill will face significant hurdles, not just in opposition from Democrats, but also from Republican Members who either feel that the bill goes too far, specifically with the elimination of the Medicaid expansion, and Republicans of the Freedom Caucus who feel the bill does not repeal enough of the government’s role in subsidizing health care coverage.

The AHCA would be a significant step backward from the ACA’s affordability and patient protections, and will hurt millions of Americans, including cancer patients and survivors. Call your Representative and Senators today and let them know that cancer patients and survivors deserve better.

Learn more about the ACA, including tips for contacting your lawmakers »

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