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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26400.
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Francis Amankwah, Erin Balogh, Melissa Maitin-Shepard, and Sharyl Nass, Rapporteurs National Cancer Policy Forum Board on Health Care Services Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS  500 Fifth Street, NW  Washington, DC 20001 This activity was supported by Contract No. 200-2011-38807 (Task Order No. 75D30120F00089) and Contract No. HHSN263201800029I (Task Order No. HHSN26300008) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the Ameri- can Association for Cancer Research, American Cancer Society, American ­College of Radiology, American Society of Clinical Oncology, Association of American ­Cancer Institutes, Association of Community Cancer Centers, Bristol Myers Squibb, ­Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Merck & Co., Inc., National Comprehensive Cancer Network, National Patient Advocate ­Foundation, Novartis Oncology, Oncology Nursing Society, Pfizer Inc., Sanofi, and Society for Immunotherapy of Cancer. Any opinions, findings, conclusions, or recom- mendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26400 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2022 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and M ­ edicine. 2022. Impact of the Affordable Care Act on cancer prevention and cancer care: ­Proceedings of a work- shop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26400. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technol- ogy. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of ­Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The state- ments and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National ­Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

WORKSHOP PLANNING COMMITTEE1 RANDALL A. OYER (Co-Chair), Medical Director, Oncology, Ann B. Barshinger Cancer Institute; Medical Director, Cancer Risk Evaluation Program, Penn Medicine Lancaster General Health; and Immediate Past President, Association of Community Cancer Centers DEBORAH SCHRAG (Co-Chair), Chief, Division of Population Sciences, Dana-Farber Cancer Institute, and Professor of Medicine, Harvard Medical School CATHY J. BRADLEY, David F. and Margaret Turley Grohne Chair for Cancer Prevention and Control Research; Professor and Associate Dean for Research, Colorado School of Public Health; Bunn Chair of Cancer Research and Deputy Director, University of Colorado Comprehensive Cancer Center ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network GWEN DARIEN, Executive Vice President, Patient Advocacy and Engagement, National Patient Advocate Foundation NICOLE F. DOWLING, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention NICOLE HUBERFELD, Professor of Law, Boston University School of Law and School of Public Health MIMI HUIZINGA, Vice President and Head, U.S. Oncology Medical, Novartis Oncology ROY A. JENSEN, Professor of Pathology and Laboratory Medicine; William R. Jewell, M.D. Distinguished Masonic Professor of Cancer Research; Director, The University of Kansas Cancer Center; Director, Kansas Masonic Cancer Research Institute, The University of Kansas Medical Center; and Immediate Past President, Association of American Cancer Institutes NEAL J. MEROPOL, Vice President of Research Oncology, Flatiron Health; and Adjunct Professor, Case Comprehensive Cancer Center 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing s­ peakers. The responsibility for the published Proceedings of a Workshop rests with the workshop ­rapporteurs and the institution. v PREPUBLICATION COPY—Uncorrected Proofs

CLEO A. SAMUEL-RYALS, Associate Professor, Department of Health Policy Management, Gillings School of Global Public Health; and Director, Centering Racial Equity in Data Science Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill ROBERT A. WINN, Director, Massey Cancer Center; and Senior Associate Dean for Cancer Innovation, Professor of Pulmonary Disease and Critical Care Medicine, and Lipman Chair in Oncology, School of Medicine, Virginia Commonwealth University ROBIN YABROFF, Scientific Vice President of Health Services Research, American Cancer Society Project Staff FRANCIS AMANKWAH, Program Officer RACHEL AUSTIN, Senior Program Assistant LORI BENJAMIN BRENIG, Research Associate ANNALEE GONZALES, Administrative Assistant KAFAYAT MAHMOUD, Christine Mirzayan Science & Technology Policy Fellow (September–November 2021) MICAH WINOGRAD, Senior Finance Business Partner ERIN BALOGH, Co-Director, National Cancer Policy Forum SHARYL NASS, Co-Director, National Cancer Policy Forum; and Senior Director, Board on Health Care Services vi PREPUBLICATION COPY—Uncorrected Proofs

NATIONAL CANCER POLICY FORUM1 EDWARD J. BENZ, JR. (Chair), President and Chief Executive Officer, Emeritus, Dana-Farber Cancer Institute; and Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School PETER C. ADAMSON, Global Head, Oncology Development and Pediatric Innovation, Sanofi GARNET L. ANDERSON, Senior Vice President and Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; and Affiliate Professor, Department of Biostatistics, University of Washington KAREN BASEN-ENGQUIST, Annie Laurie Howard Research Distinguished Professor, Professor of Behavioral Science, and Director, Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center SMITA BHATIA, Professor and Vice Chair of Outcomes for Pediatrics; Gay and Bew White Endowed Chair in Pediatric Oncology; Director, Institute for Cancer Outcomes and Survivorship; and Associate Director for Outcomes Research, Comprehensive Cancer Center, The University of Alabama at Birmingham CHRIS BOSHOFF, Chief Development Officer, Oncology, Global Product Development, Pfizer Inc. CATHY J. BRADLEY, David F. and Margaret Turley Grohne Chair for Cancer Prevention and Control Research; Professor and Associate Dean for Research, Colorado School of Public Health; Bunn Chair of Cancer Research and Deputy Director, University of Colorado Comprehensive Cancer Center OTIS W. BRAWLEY, Bloomberg Distinguished Professor, Department of Epidemiology, Bloomberg School of Public Health and Department of Oncology, School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University CYNTHIA BROGDON, Head, U.S. Oncology Portfolio Strategy, Bristol Myers Squibb 1 The National Academies of Sciences, Engineering, and Medicine’s forums and round- tables do not issue, review, or approve individual documents. The responsibility for the pub- lished Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vii PREPUBLICATION COPY—Uncorrected Proofs

WILLIAM G. CANCE, Chief Medical and Scientific Officer, American Cancer Society ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network CHRISTINA CHAPMAN, Assistant Professor of Radiation Oncology, University of Michigan GWEN DARIEN, Executive Vice President, Patient Advocacy and Engagement, National Patient Advocate Foundation NANCY E. DAVIDSON, President and Executive Director, Seattle Cancer Care Alliance; Raisbeck Endowed Chair for Collaborative Research, Senior Vice President, Director, and Professor, Clinical Research Division, Fred Hutchinson Cancer Research Center; and Head, Department of Medicine, Division of Medical Oncology, University of Washington JAMES H. DOROSHOW, Director, Division of Cancer Treatment and Diagnosis; Deputy Director for Clinical and Translational Research; and Head, Oxidative Signaling and Molecular Therapeutics Group, National Cancer Institute NICOLE F. DOWLING, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention SCOT W. EBBINGHAUS, Vice President and Therapeutic Area Head, Oncology Clinical Research, Merck Research Laboratories KOJO S. J. ELENITOBA-JOHNSON, Professor, Perelman School of Medicine; and Director, Center for Personalized Diagnostics and Division of Precision and Computational Diagnostics, University of Pennsylvania STANTON L. GERSON, Director, Case Comprehensive Cancer Center; Interim Dean and Senior Vice President, Medical Affairs, School of Medicine; Professor, Department of Medicine and Department of Environmental Health Sciences; and Director, National Center for Regenerative Medicine, Case Western Reserve University JULIE R. GRALOW, Executive Vice President and Chief Medical Officer, American Society of Clinical Oncology ROY S. HERBST, Ensign Professor of Medicine and Professor of Pharmacology; Director, Center for Thoracic Cancers; Chief of Medical Oncology, Yale Cancer Center and Smilow Cancer Hospital; and Associate Cancer Center Director, Translational Science, Yale School of Medicine viii PREPUBLICATION COPY—Uncorrected Proofs

HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center CHANITA HUGHES-HALBERT, Vice Chair for Research and Professor, Department of Preventive Medicine; and Associate Director for Cancer Equity, Norris Comprehensive Cancer Center, University of Southern California MIMI HUIZINGA, Vice President and Head, U.S. Oncology Medical, Novartis Oncology ROY A. JENSEN, Professor of Pathology and Laboratory Medicine; William R. Jewell, M.D. Distinguished Masonic Professor of Cancer Research; Director, The University of Kansas Cancer Center; Director, Kansas Masonic Cancer Research Institute, The University of Kansas Medical Center; and Immediate Past President, Association of American Cancer Institutes RANDY A. JONES, Professor and Assistant Director of Community Outreach and Engagement, University of Virginia School of Nursing, University of Virginia Cancer Center BETH Y. KARLAN, Vice Chair, Women’s Health Research; Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine; and Director, Cancer Population Genetics, Jonsson Comprehensive Cancer Center, University of California, Los Angeles SAMIR N. KHLEIF, Director, Jeannie and Tony Loop Immuno-Oncology Lab; Biomedical Scholar and Professor of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center MIA LEVY, Chief Medical Officer, Foundation Medicine SCOTT M. LIPPMAN, Director, Moores Cancer Center; Distinguished Professor of Medicine, Senior Associate Dean, and Associate Vice Chancellor for Cancer Research and Care; and Chugai Pharmaceutical Chair in Cancer, University of California, San Diego NEAL J. MEROPOL, Vice President of Research Oncology, Flatiron Health; and Adjunct Professor, Case Comprehensive Cancer Center LARISSA NEKHLYUDOV, Professor of Medicine, Harvard Medical School; Internist, Brigham and Women’s Hospital; and Clinical Director, Internal Medicine for Cancer Survivors, Dana-Farber Cancer Institute RANDALL A. OYER, Medical Director, Oncology, Ann B. Barshinger Cancer Institute; Medical Director, Cancer Risk Evaluation Program, Penn Medicine Lancaster General Health; and Immediate Past President, Association of Community Cancer Centers ix PREPUBLICATION COPY—Uncorrected Proofs

CLEO A. SAMUEL-RYALS, Associate Professor, Department of Health Policy Management, Gillings School of Global Public Health; and Director, Centering Racial Equity in Data Science Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill RICHARD L. SCHILSKY, Principal Investigator, American Society of Clinical Oncology Targeted Agent and Profiling Utilization Registry Study; and Professor Emeritus, University of Chicago JULIE SCHNEIDER, Associate Director, Research Strategy and Partnership, Oncology Center of Excellence, U.S. Food and Drug Administration SUSAN M. SCHNEIDER, Associate Professor Emerita, School of Nursing, Duke University LAWRENCE N. SHULMAN, Professor of Medicine, Deputy Director for Clinical Services, and Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania LARA STRAWBRIDGE, Director, Division of Ambulatory Payment Models, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services GEORGE J. WEINER, C.E. Block Chair of Cancer Research, Professor of Internal Medicine and Pharmaceutical Science; and Director, Holden Comprehensive Cancer Center, The University of Iowa ROBERT A. WINN, Director, Massey Cancer Center; and Senior Associate Dean for Cancer Innovation, Professor of Pulmonary Disease and Critical Care Medicine, and Lipman Chair in Oncology, School of Medicine, Virginia Commonwealth University PHYLICIA L. WOODS, Executive Director, Cancer Policy Institute, Cancer Support Community National Cancer Policy Forum Staff FRANCIS AMANKWAH, Program Officer RACHEL AUSTIN, Senior Program Assistant LORI BENJAMIN BRENIG, Research Associate ANNALEE GONZALES, Administrative Assistant MICAH WINOGRAD, Senior Finance Business Partner ERIN BALOGH, Co-Director, National Cancer Policy Forum SHARYL J. NASS, Co-Director, National Cancer Policy Forum; and Senior Director, Board on Health Care Services x PREPUBLICATION COPY—Uncorrected Proofs

Reviewers This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in mak- ing each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: MELINDA B. BUNTIN, Vanderbilt University School of Medicine SUSAN J. CURRY, The University of Iowa FOLASADE (FOLA) MAY, University of California, Los Angeles BARBARA L. McANENEY, Oncology Hematology Consultants, Ltd. Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the pro- ceedings nor did they see the final draft before its release. The review of this proceedings was overseen by LESLIE SIM, National Academies of Sciences, Engineering, and Medicine. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. xi PREPUBLICATION COPY—Uncorrected Proofs

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Acknowledgments Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Nonfederal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society of Clinical Oncology, Association of American Cancer Institutes, Asso- ciation of Community Cancer Centers, Bristol Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Merck & Co., Inc., National Comprehensive Cancer Network, National Patient Advocate Foundation, Novartis Oncology, Oncology Nursing Society, Pfizer Inc, Sanofi, and Society for Immunotherapy of Cancer. The forum wishes to express its gratitude to the expert speakers whose presentations helped to highlight the current evidence base on the effects of the Affordable Care Act on people at risk for or living with cancer, as well as gaps in the evidence base, and to provide insight into remaining policy chal- lenges that could inform future efforts to improve and support the delivery of high-quality cancer care across the care continuum. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda. xiii PREPUBLICATION COPY—Uncorrected Proofs

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Contents ACRONYMS AND ABBREVIATIONS xix PROCEEDINGS OF A WORKSHOP 1 WORKSHOP OVERVIEW 1 CONSUMER PROTECTIONS IN THE ACA 4 Coverage for Preexisting Conditions, 4 Benefit Design, 6 Cost, 8 Network Adequacy, 8 Enrollment, 9 MEDICAID EXPANSION AND NON-EXPANSION 9 The Status of Medicaid Coverage Before the ACA, 9 Current Status and Paths to Medicaid Expansion, 9 THE IMPACT OF THE ACA ON CANCER PREVENTION AND CARE 13 Utilization of Cancer Screening, Prevention, and Treatment Services, 13 Decreasing Inequities in Coverage of Cancer Screening and Surveillance, 15 Addressing the Remaining Barriers to Coverage of Preventive Services, 16 xv PREPUBLICATION COPY—Uncorrected Proofs

xvi CONTENTS PROTECTIONS FOR ADOLESCENT AND YOUNG ADULT POPULATIONS 17 Impact of the ACA on Children and Adolescents and Young Adults with Cancer, 18 IMPACT OF ORGANIZATIONS CREATED BY THE ACA ON CANCER RESEARCH AND CARE 20 CMMI, 20 Options for Improving Alternative Payment Methodologies, 23 PCORI, 24 Cancer-Related Initiatives at PCORI, 25 PROGRESS, CHALLENGES, AND NEXT STEPS FOR HEALTH CARE REFORM 26 Access to Care, 26 Quality of Care, 27 Social Determinants of Health, 29 Reducing Costs, 34 Effective Care Models, 35 CONCLUDING REMARKS 37 REFERENCES 38 APPENDIX A: STATEMENT OF TASK 45 APPENDIX B: WORKSHOP AGENDA 47 PREPUBLICATION COPY—Uncorrected Proofs

Boxes and Figures BOXES 1 Key Patient Protections in the Patient Protection and Affordable Care Act, 2 2 Observations from Individual Workshop Participants on the Impact of the Patient Protection and Affordable Care Act on Cancer Prevention and Cancer Care, 3 3 Suggestions from Individual Workshop Participants to Build on the Impact of the Patient Protection and Affordable Care Act to Advance Cancer Prevention and Cancer Care, 5 4 Examples of States’ Experiences in Moving Toward Expansion, 11 5 Key Takeaways from the Evaluation of the Oncology Care Model (performance periods 1–5), 22 FIGURES 1 Map showing the status of Medicaid expansion by state, as of March 1, 2021, 10 2 Map showing state-by-state coverage of lung cancer screening in Medicaid fee-for-service programs, 17 xvii PREPUBLICATION COPY—Uncorrected Proofs

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Acronyms and Abbreviations ACA Patient Protection and Affordable Care Act ACO accountable care organization APHA American Public Health Association ASCO American Society of Clinical Oncology AYA adolescent and young adult BIPOC Black, Indigenous, and people of color CMMI Center for Medicare & Medicaid Innovation CMS Centers for Medicare & Medicaid Services CQI Collaborative Quality Initiative EHR electronic health record FPL federal poverty level HHS U.S. Department of Health and Human Services MEOS Monthly Enhanced Oncology Services NCI National Cancer Institute OCM Oncology Care Model xix PREPUBLICATION COPY—Uncorrected Proofs

xx ACRONYMS AND ABBREVIATIONS PCORI Patient-Centered Outcomes Research Institute PLACER Phased Large Awards for Comparative Effectiveness Research RO radiation oncology PREPUBLICATION COPY—Uncorrected Proofs

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The National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop in March 2021 to examine the existing evidence base on how the Patient Protection and Affordable Care Act (ACA) has altered the landscape of cancer prevention and care delivery in the United States. The workshop featured presentations and discussions reviewing the effects of the ACA on people at risk for or living with cancer and providing insight into remaining policy challenges that could inform future efforts to improve and support the delivery of high-quality cancer care across the care continuum. This publication provides a high-level summary of the discussions presented during the workshop.

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