Tag Archives: ACA reform

Tax Reform Bill Moves to Conference Committee

By Blair Burnett, ACCC Policy Analyst

U.S. CapitolEarly Saturday morning, December 2, 2017, the U.S. Senate passed their version of the tax reform bill, which included several provisions that may have a significant impact on access to care for cancer patients. The U.S. House of Representatives passed their version of the tax reform bill in November, and with some key differences between both bills, the Administration’s push for a legislative win with tax reform – as well as the need for a year-end spending bill – will surely create some partisan fireworks in the last weeks of 2017.

The House and Senate tax reform bills are now being negotiated in conference committee, where the details of the final bill will be ironed out before being voted on again in both chambers. With a possible government shutdown looming and budget reconciliation running out of time, Congress is under pressure to act quickly. Given the notable dissension within both houses of Congress, conferencing the tax reform bill will be difficult, specifically with key healthcare policies included. ACCC has expressed serious concerns about the impact several healthcare-related provisions will have on access to care for cancer patients, most notably:

  • Repeal of the Affordable Care Act (ACA) Individual Mandate: Independent experts estimate that repealing the individual mandate will increase premiums by 10% and leave 13 million more Americans uninsured.
  • Triggering Sequestration: Both tax reform packages include such a significant increase in the federal deficit that these bills would trigger sequestration, requiring a $25 billion annual cut to Medicare.
  • Repeal or reduction of the Medical Expense Deduction: The House package would repeal the medical expense deduction, exacerbating the financial toll cancer takes on patients and their families.

ACCC is deeply concerned that the two versions of the bill, as written, will have a detrimental impact on access to quality cancer care for cancer patients across the country. ACCC sent a letter to Congress about the current proposals, asking that legislators consider the impact these policies will have on access to cancer care, particularly for millions of Medicare patients newly diagnosed with cancer or those currently living with the disease. “ACCC is committed to providing the highest quality cancer care to our patients, and we believe our ability to do so will be threatened if these policies are included in the final version of the bill,” said ACCC President Mark S. Soberman, MD, MBA, FACS.

The ACCC policy team will keep you updated on tax reform negotiations and alert you to continued opportunities to advocate for your patients and policies that support the cancer care delivery system. To advocate for changes to the final tax reform bill, please contact your representatives here.

Are We There Yet? Approaching a Bipartisan Compromise on Healthcare

By Blair Burnett, ACCC Policy Analyst

U.S. CapitolAfter a flurry of activity on healthcare over the past couple of months, a bipartisan proposal may be making gains in Congress. The highlights:

October 12, 2017 – The Trump Administration released an executive order that laid the groundwork for big changes to the Affordable Care Act (ACA) marketplaces including less comprehensive plans offered through associations of small employers as well as a push for increased use of short-term medical coverage. This could essentially create an alternative insurance market that would not have to comply with many of the consumer protections created under the ACA, and would likely attract healthier, less costly consumers, which would drive up premiums in the current exchanges. Later that evening, the Administration announced it would immediately end cost-sharing reduction (CSR) payments used to subsidize healthcare costs for low-income individuals on the exchanges. The legal battle around CSRs has been playing out in the courts since 2014, with some arguing that the payments are illegal because they were not appropriated by Congress. Analysis from the Congressional Budget Office (CBO) predicts large premium increases for exchange plans in 2018 and beyond, as insurers attempt to cover the loss of the CSR payments and some consider leaving the marketplaces all together.

October 17, 2017 – The following week, Chairman and Ranking Member of the Senate Health, Education, Labor, and Pensions Committee (HELP), Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), announced a bipartisan bill designed to provide temporary stability in the marketplaces.

Key tenets of the Alexander-Murray proposal include:

  • Continued Funding for CSR Payments: CSRs would continue to be funded through 2019. For states where insurance regulators are pressing individual insurers to decline this payment, no funding would be issued.
  • Restoration of ACA Enrollment Funding: Any state participating in an exchange would see restoration of over $100 million in outreach and enrollment funding through 2019. This proposal also seeks transparency with open enrollment advertising and outreach with a mandated reporting timeline.
  • Preexisting Conditions & Essential Health Benefits Coverage Requirements: Under this bipartisan proposal, insurers would not be able to waive the ACA preexisting conditions or ten Essential Health Benefits (EHBs), which became coverage requirements under the ACA, as previous ACA reform/replace bills have sought to do.
  • Section 1332 Waivers Support: This proposal would streamline the waiver process and make it easier for states to acquire and maintain 1332 waivers. These allow states to implement their own health insurance programs as long as they meet thresholds for coverage and affordability that are similar to those achieved under the ACA.

Despite early support among both Democrats and Republicans in the Senate and pushing healthcare reform forward, last week President Trump signaled a singular focus on tax reform while meeting with Congressional leadership, suggesting there may not be a clear path forward. The Alexander-Murray proposal would also likely face an up-hill battle in the House where Majority Leadership is still focused on ACA repeal and replace. On October 25, the Congressional Budget Office (CBO) released an initial impact analysis of this proposal citing a deficit reduction of nearly $4 billion through 2027. Even with that news, the likelihood of this bill to move on its own appears slim; the most likely pathway for this proposal to become law, if at all, will be tacking it on to a “must pass” end of year funding bill.

Regardless of how – or when – the short-term stabilization package moves, the Administration’s announcement to end the CSR payments has already made an impact. Early estimates show that premiums for a silver-level plan in 2018 will increase 34%, higher than the average 25% increase we saw in 2017, and not all enrollees will qualify for the premium tax credits used to offset these market increases.[1] Without CSR payments, insurers will also likely continue to exit ACA exchanges in many states, leading to states with fewer options and an unstable market overall. For cancer patients, and those battling chronic illnesses, efforts by the Administration to loosen regulatory requirements around comprehensive coverage and decisions to end critical funding streams to assist insurers in providing meaningful coverage for the costliest consumers is particularly troubling and will mean higher cost plans and fewer options.

And, amid all this uncertainty, Open Enrollment season is upon us. The Enrollment Period for ACA Exchanges has been scaled back to 45 days under the current administration, and will occur from November 1 through December 15, 2017.

ACCC will continue to monitor any legislative progress of the bipartisan market stabilization bill and continue to advocate for comprehensive, affordable insurance options for all cancer patients. For more on what ACCC needs to see in any ACA reform proposal, see our Health Reform Principles for Cancer Patients.


[1] avalere.com/expertise/managed-care/insights/silver-exchange-premiums-rise-34-on-average-in-2018

CANCERSCAPE Kicks Off with Perspectives on Policy and Business

by Amanda Patton, ACCC Communications

Last week’s events on Capitol Hill provided a dramatic backdrop for the ACCC 43rd Annual Meeting, CANCERSCAPE, March 29-31, bringing together hundreds of oncology professionals from around the country for insights, strategies, and perspective in the midst of healthcare reform ambiguities.

Cancerscape 2017-keynote panelIn a keynote session Thursday morning, policy insiders Kavita Patel, MD, MS, of The Brookings Institution, and Dan Todd, JD, Todd Strategy, LLC, shared insights on possible next steps toward Affordable Care Act (ACA) repeal or repair under the Trump Administration. ACCC Health Policy Director Leah Ralph moderated the point-counterpoint discussion covering what went wrong with the House Republicans’ American Health Care Act (AHCA) legislative effort at ACA repeal, mounting political pressures on Capitol Hill, legislative or administrative options to effect ACA repair, flaws in the design of the faltering individual insurance exchanges and what may (or may not) happen next, and whether the Administration will act on the hot button issue of drug pricing.

Cancerscape 2017 keynote panel 2Asked for one final takeaway that attendees should bring back to their programs to help their colleagues understand the policy landscape, Dr. Patel shared this perspective for frontline clinicians and administrators:

“No matter who is the party in power there’s always going to be this emphasis on cost. I don’t see the pressure to decrease costs going away. It may come in the form of programs like MIPS and commercial programs like ACOs and patient-centered medical homes, but as a physician who is in all of those programs, it’s all about having me [as a physician] understand where I’m over utilizing care . . . . If there’s one takeaway . . . it’s not to sit . . . and wait to see how things shake out.” Start looking for where you have unwarranted variation, where you can start implementing programs that actually matter to patients, Dr. Patel advised. “Take back some introspective ability to look at your variation, look at your costs, look at all the things that fall into P & L for administrators and how do you translate that to where clinical care is delivered.”

Dan Todd left attendees with one final advocacy takeaway: “It’s a new Administration with training wheels still on. . . they’ll ultimately get their balance. . . . If you have priorities, educate your congressional members on [them]. . . your voice is really, really important.”

For more, read OncLive’s coverage of the session here.

Conway-The Advisory BoardThe morning’s second session shifted the focus outside the Beltway to explore emerging cancer care delivery trends and potential impact on the business of providing cancer care. Lindsay Conway, MSEd, of The Advisory Board, briefed attendees on The State of Today’s Cancer Programs, highlighting five key trends shaping the delivery and business cancer care delivery:

  • Healthcare reimbursement and reform is at a pivotal point. Uncertainty continues around the future of the ACA and the insurance exchanges.
  • Increasing numbers of cancer patients with comorbidities requiring enhanced care coordination. From 2000 to 2010, the number of Medicare patients with multiple chronic conditions grew 22%. Proactive steps in care coordination for this population include regular distress screening to identify issues early and devising and implementing care maps for navigators.
  • Telehealth technology bringing care to patients where they are. These technologies and emerging patient-centered tools—ranging from real-time virtual visits, to phone apps, to patient portals, to remote patient monitoring—have tremendous capacity for expanding patient access to care
  • Growth of healthcare consumerism requiring cost and quality information. There are growing online resources for healthcare review, cost and quality information. To address consumerism in cancer care, it’s important for cancer programs to provide information to help patients select the right provider and the right services.
  • Genomic medicine is transforming cancer care. With the rapid pace of change in this area, cancer programs are challenged to invest carefully as they move forward to integrate precision medicine into practice.

More coverage on this session is available here.  To learn more about the ACCC 43rd Annual Meeting, CANCERSCAPE,  visit us at accc-cancer.org.

Why I’m Going to Capitol Hill On March 29

By Virginia Vaitones, MSW, OSW-C

U.S. CapitolACCC Capitol Hill Day 2017 happens to coincide with national Social Work Month, which the National Association of Social Workers is marking with theme Social Workers Stand Up.  As an oncology social worker, this year I’m putting on my patient advocate’s hat, standing up, and going to Capitol Hill to share with legislators the stories of how my patients are being impacting by worry and uncertainty about how  changes to the Affordable Care Act and the Medicaid program may affect their insurance coverage and access  to care.

My home state of Maine has the distinction of having the oldest population in the country per capita and Knox County, where I live and work, has the oldest population in the state.  Many of my patients who are on Medicare also have MaineCare (Maine’s Medicaid program) as their secondary insurance.  The current proposed changes to how the federal government supports states with Medicaid funding will have a tremendous impact on my patients.

Besides the elderly population that I need to advocate for, the proposed cuts and changes in payment will have an impact on my younger patients who become disabled with their cancer diagnosis and depend on Medicaid to cover the cost of their cancer treatments.  As a patient advocate, I will be standing up for these patients as well.

My advocacy skills also are needed to bring the stories of how cancer impacts parents, small business owners, and working adults with a cancer diagnosis, who for the first time were able to afford health insurance under the ACA and now face uncertainty about whether they will have coverage or be able to continue to afford the cost of coverage.

Last but not least, I work in a rural community hospital whose doors are always open and that will treat patients whether or not they have insurance coverage.  I need to advocate for my hospital so that we can keep our doors open.

Capitol Hill Day, March 29, will bring together ACCC members representing cancer programs from across the country.  Together we will be standing up for our patients, for access to quality care close to home, and for our cancer programs.


Virginia Vaitones, MSW, OSW-C, is oncology social worker at Pen Bay Medical Center in Rockport, Maine, and a past president of the Association of Community Cancer Centers (ACCC). 

Speak Up Now!

by Leah Ralph, Director of Health Policy, ACCC

U.S. CapitolFor this year’s ACCC Capitol Hill Day, Wednesday, March 29, ACCC advocates will descend on Washington, D.C., with newfound motivation. As Congress grapples with the future of the Affordable Care Act (ACA) and debates the merits of protecting patients with pre-existing conditions vs. high-risk pools, refundable tax credits vs. subsidies, requirements for essential health benefits vs. more flexibility in benefit standards, oncology care providers see insurance coverage—and their patients’ access to cancer care—at stake.

Yes, It’s Complicated
The political messaging—not to mention policy minutiae—is difficult to sort through, even for the wonkiest of policy wonks in Washington. The ACA has been plagued with insurer drop outs and significant premium increases for the unsubsidized individual market, but the law has also provided critical patient protections, put an end to discriminatory practices by insurers, and covered 20 million new lives through Medicaid expansion and the health insurance exchanges. Having made ACA repeal their rallying cry for years, Republicans are now trying to find a path forward to make changes to the law. But maintaining those critical (and politically popular) patient protections, preserving essential benefits, and covering more people while also reducing costs for both the system and the patients is far from an easy task.

Preserve Patient Protections
More than ever before, this year on Capitol Hill Day, ACCC members have a critical story to tell about the unique needs of cancer patients and the costs of their treatment. Cancer, in many ways, demonstrates the precise need—and role—for insurance. Cancer diagnoses are inherently unpredictable. Cancer patients can’t plan when they are going to be sick or what kind of insurance they will need to cover their costs. In addition to the personal, emotional, and physical toll a cancer diagnosis takes on individuals and their families, cancer patients need good insurance to protect against the risk of catastrophic treatment costs.

The ACA created critical protections for consumers, including eliminating the ability of insurance companies to discriminate based on a pre-existing condition, like cancer, or to impose lifetime or annual dollar limits on policies. And by providing subsidies to those up to 400 percent of the federal poverty level to purchase insurance, the ACA made progress in closing the disparities gap in accessing cancer care.

Protect Patient Access to Care
In record numbers, ACCC members will set out on March 29 to educate Congress on what proposed changes to the ACA would mean for cancer patients and survivors and their ability to access high quality cancer care in the communities where they live and work. In the context of any ACA repeal and/or replace plan, ACCC members will ask legislators to:

  • Protect access to comprehensive, affordable insurance coverage. This is particularly critical for cancer patients facing high-cost treatments that often turn into chronic, long-term conditions.
  • Preserve critical patient protections, such as the ban on discriminating based on pre-existing conditions, no annual or lifetime limits, guaranteed issue, and allowing dependents to remain on their parents’ plan until age 26.
  • Preserve essential health benefits that require insurers to cover preventive services, like cancer screenings, at minimal or no cost-sharing.
  • Maintain meaningful access to clinical trials.
  • Strengthen patient access to adequate provider networks that include cancer specialists and the full range of services required to provide quality cancer care.
  • Meaningfully engage cancer patient and provider groups in any real effort to repeal and/or replace the ACA.

Beyond coverage and access, ACCC members will also reiterate their commitment to value-based care and any efforts to improve quality, affordability, and access in cancer care. ACCC has long been committed to working with the Centers for Medicare & Medicaid Services (CMS) to achieve true high-value, cost-effective cancer care. ACCC members support the mission and goals of the ACA-created Center for Medicare and Medicaid Innovation (CMMI), which has been the subject of recent scrutiny. More than half of the CMMI Oncology Care Model (OCM) participating practices are ACCC members. These forward-thinking practices are dedicating significant time and resources to making this pilot program work.

However, in the wake of last year’s CMMI ill-conceived proposed Part B Drug Payment Model, ACCC members will also strongly encourage Congress to place additional guardrails on CMMI’s authority, including limiting its scope to targeted, voluntary (rather than mandatory) demonstration programs.

ACCC members have a lot to communicate to busy Congressional representatives and staffers this year. But the stories we will share, from the communities in which ACCC members are working on the frontlines of cancer care, will bring home the impact of policy decisions in the clearest, most powerful terms. Now is a critical time to speak up and be heard—for our patients today and those who will become our patients tomorrow. Join us for ACCC Capitol Hill Day. Your story can make a difference.


The ACCC 43rd Annual Meeting, CANCERSCAPE, March 29-31, will provide a 360-degree look at the healthcare landscape from the Democrat and Republican perspectives with insights on what to expect for reimbursement, alternative payment models, drug pricing, quality reporting, and more. Learn more.