The Impact of the Affordable Care Act on Cancer Prevention and Cancer Care Proceedings of a Workshop (2022) / Chapter Skim
Currently Skimming:
Proceedings of a Workshop
Proceedings of a Workshop
Pages 1-44
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
at the time. Sebelius noted that the main goals of the ACA were to expand access to affordable, high-quality health insurance; increase consumer insurance protections; improve the quality of health care; strengthen prevention and wellness; and support innovative care delivery models that reduce costs and/or improve quality.2 On March 1–2, 2021, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine convened a 1.5-day virtual public workshop to examine the impact of the ACA on cancer prevention and care.
|
From page 2... ...
or above 100 percent FPL in some states without Medicaid expansion • Limits on deductibles and out-of-pocket costs • Coverage of a minimum set of 10 essential health benefits • Coverage of preventive services without cost sharing • Consistent coverage across bronze, silver, gold, and platinum marketplace plans • Coverage for dependents up to age 26 on a parent's plan SOURCES: Glied presentation, March 1, 2021; Keith presentation, March 1, 2021. See https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdf (accessed September 7, 2021)
|
From page 3... ...
• Though limited, evidence suggested that increased access to cancer screening (facilitated by Medicaid expansion) led to identification of tumors at earlier stages so treatment could begin earlier, which can lead to improved patient outcomes and in some cases, less impact on patient finances.
|
From page 4... ...
. 3 See https://www.nationalacademies.org/event/03-01-2021/the-impact-of-the-affordable care-act-on-cancer-prevention-and-cancer-care-a-virtual-workshop-part-1#sl-three-columnsae50cfbb-994c-41f7-99b7-71f6551ce37d (accessed September 7, 2021)
|
From page 5... ...
• Enforce regulations to prevent short-term insurance coverage from being sold on a long-term basis, and clearly inform con sumers on the type of plan being purchased. (Fishman, Glied, Keith)
|
From page 6... ...
Keith pointed out that coverage of preventive services without cost sharing may play a key role in expanding access to preventive care, especially for people with 4 For more information on the 10 essential health benefits, see https://www.healthcare.gov/ coverage/what-marketplace-plans-cover (accessed October 13, 2021)
|
From page 7... ...
• Link health equity to care quality through payment models. (Strawbridge)
|
From page 8... ...
Glied noted that out-of-pocket maximums for individuals enrolled on marketplace plans can be quite high, especially among those with serious illness: "If you need a lot of care -- if you are at the 99th percentile of that spending distribution -- you may have to pay as much as $18,000 a year in combination for your premium and your out-of-pocket expenditures" (see also the section on Cost Sharing)
|
From page 9... ...
as in the Southwest and Midwest. Current Status and Paths to Medicaid Expansion The ACA called on states to expand Medicaid eligibility to adults with incomes up to 138 percent FPL.
|
From page 10... ...
Riley said that, given the breadth of Medicaid responsibilities, agencies do not generally use disease-specific approaches. However, all state Medicaid FIGURE 1 Map showing the status of Medicaid expansion by state, as of March 1, 2021.
|
From page 11... ...
Tribal partners have also supported expansion because the 39 recognized tribes in the state must pay for care for their members who are uninsured. The state also has a goal to increase access to preventive services, including cancer screening.
|
From page 12... ...
Medicaid expansion would provide health care eligibility to 600,000 residents of North Carolina who lack health insurance, Richard stressed.
|
From page 13... ...
episode of care payments and provide increased support for palliative care. THE IMPACT OF THE ACA ON CANCER PREVENTION AND CARE Workshop speakers discussed how the ACA has increased utilization of cancer preventive services and has helped to decrease inequities in coverage of cancer screening and care.
|
From page 14... ...
. But Sabik noted that although cancer screenings increased as a result of the ACA, leading to earlier detection of cancers, questions remain about the extent to which the increases in screening have benefited populations that have long experienced barriers to care, and whether patient outcomes are improving due to earlier detection of cancers.
|
From page 15... ...
Decreasing Inequities in Coverage of Cancer Screening and Surveillance Fola May, assistant professor of medicine at the University of California, Los Angeles, described several components of the ACA that provide opportunities to reduce inequities in access to cancer screenings and other care services. She said that increasing access to health insurance through Medicaid expansion has had a positive effect on health outcomes.
|
From page 16... ...
She also noted that the difference between current rates of colorectal cancer screening and the goal of the National Colorectal Cancer Roundtable11 -- screening 80 percent of eligible people in every community -- is wider for racial/ethnic minority populations, suggesting that substantial investments beyond the ACA are needed to reach screening goals. Addressing the Remaining Barriers to Coverage of Preventive Services Stacey A
|
From page 17... ...
Another gap in coverage of cancer preventive services is that states can decide whether or not to cover cancer screenings under traditional Medicaid. For example, Fedewa noted, current or former smokers, for whom lung cancer screening is recommended, are disproportionately likely to be enrolled in Medicaid, and in 12 states traditional Medicaid may not cover lung cancer screening at all, as shown in Figure 2.
|
From page 18... ...
Also, Medicaid expansion has helped to reduce family financial burdens and free up resources for families to access preventive care. 13 See https://seer.cancer.gov/statfacts/html/aya.html (accessed September 9, 2021)
|
From page 19... ...
Also, prior to the ACA, uninsured AYA cancer survivors experienced barriers to acquiring health insurance coverage due to preexisting conditions (Park et al., 2012, 2015; Warner et al., 2013)
|
From page 20... ...
Park noted that interventions are needed at the individual, community, and care system level to increase health insurance coverage and access to care for AYA cancer survivors. She suggested patient navigation as an intervention.
|
From page 21... ...
Participating oncology practices represent approximately 25 percent of chemotherapy-related care in fee-for-service Medicare. OCM practices are required to perform six fundamental transformation processes aimed at redesigning their care, including provision of patient navigation, care planning, 24/7 access, use of national guidelines, use of data for quality improvement, and use of certified electronic health record (EHR)
|
From page 22... ...
. 17 See http://www.comehomeprogram.com (accessed September 9, 2021)
|
From page 23... ...
Options for Improving Alternative Payment Methodologies Donald Berwick, president emeritus and senior fellow with the Institute for Healthcare Improvement and former administrator of CMS, noted that of the 55 models CMMI has tested so far, only 4 have been certified for expansion 18 See https://innovation.cms.gov/innovation-models/radiation-oncology-model (accessed September 9, 2021)
|
From page 24... ...
She suggested that CMMI consider embedding people with cancer in other large demonstration projects and using value-based payment models to address social determinants of health that present barriers to people with cancer receiving quality care. Strawbridge agreed that there is much to learn about why OCM has not achieved its intended outcomes, but noted that improvements in quality or health care utilization could still be realized before the model is completed.
|
From page 25... ...
Clauser noted that PCORI's research awards cover the cancer care continuum and different cancer types and include a focus on patient and clinician education and care delivery strategies related to models of care, equitable access to screening, telemedicine, and patient navigation. PCORI research is 19 See https://www.pcori.org/topics/cancer (accessed September 24, 2021)
|
From page 26... ...
Impact on social determinants of health 4. Reductions in health care cost, without causing harm or rationing care Access to Care Berwick said that health care reform should recognize health care as a human right, noting that the United States is the only Western democracy in which health care is not available to all by law.
|
From page 27... ...
She said that the most significant gap was created when a Supreme Court ruling made Medicaid expansion optional. Sebelius and Glied noted that some Americans who live in states that have not expanded Medicaid are left in the "Medicaid coverage gap" because their income is too low to quality for federally subsidized health insurance in the marketplaces.
|
From page 28... ...
Additinally, Berwick suggested broadening the dimensions of quality and empowering patients by asking what matters most to them. Patient Protections Glied provided several suggestions for strengthening patient protections in marketplace plans.
|
From page 29... ...
Social Determinants of Health Berwick stated that addressing social determinants of health is the "greatest frontier" in health and health care and that all health care reforms should invest in improving social determinants of health. He noted that most health harms come from issues beyond health care, such as environmental concerns, lack of educational opportunities, lack of security, and inadequate support for the well-being of children in a community.
|
From page 30... ...
. Berwick stated that the greatest barrier to addressing social determinants of health is moving money from the current distributions to investments that address the social determinants of health and health inequities.
|
From page 31... ...
Moreover, Benjamin said that people with more education and health literacy are more likely to seek out cancer screenings and high-quality care compared to people with less education. He added that income inequality also leads to health inequities, but several provisions in the ACA have helped to mitigate this relationship, such as coverage for preventive screenings without patient cost sharing.
|
From page 32... ...
An executive order on January 28, 2021, Strengthening Medicaid and the Affordable Care Act,23 created an open enrollment period for the federal marketplace from February 15–May 15, 2021. In addition, the executive order directs HHS to perform a regulatory review to ensure that Medicaid is being implemented as intended, with year-round open enrollment and no additional barriers to access, such as work requirements.
|
From page 33... ...
APHA addresses the social determinants of health through policies that enable income support 24 See https://chip.unc.edu/research/population-informatics (accessed September 24, 2021)
|
From page 34... ...
He suggested other ways to reduce health care costs, including simplifying or eliminating processes that do not add value, such as nonessential administrative tasks; coordinating and integrating care; and advancing virtual and home-based care, with a focus on access and equity. Other speakers addressed patient cost sharing and value-based payments.
|
From page 35... ...
Sebelius also suggested providing increased premium supports for people in marketplace plans, including people with incomes above 400 percent FPL. Sebelius also lauded a provision in the American Rescue Plan that would cover the cost of continuation of health insurance through the Consolidated Omnibus Budget Reconciliation Act25 for 1 year for people who are unemployed with incomes below 150 percent FPL.
|
From page 36... ...
Randall Oyer, medical director of oncology at Penn Medicine Lancaster General Health, asked how to make cancer patient navigation reimbursable, pointing out that patient navigation reduces the overall cost of care and emergency department visits, yet most programs are grant funded. Strawbridge responded that OCM requires all participating oncology practices to implement patient navigation activities as a condition of receiving the monthly MEOS 26 See https://ihpi.umich.edu/CQIs (accessed September 9, 2021)
|
From page 37... ...
CONCLUDING REMARKS The workshop discussion included the ways in which the ACA has transformed cancer prevention and treatment, and identified specific opportunities and challenges in providing access to quality, affordable health insurance, preventive cancer care, and cancer treatment services. Berwick said that the
|
From page 38... ...
2018. The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients.
|
From page 39... ...
2019. Changes in breast and colorectal cancer screening after Medicaid expansion under the Affordable Care Act.
|
From page 40... ...
2019. Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
|
From page 41... ...
2012. Childhood Cancer Survivor Study participants' perceptions and knowledge of health insurance coverage: Implications for the Affordable Care Act.
|
From page 42... ...
2017. The impact of health insurance on preventive care and health behaviors: Evidence from the first two years of the ACA Medicaid expansions.
|
From page 43... ...
2018. Changes in insurance coverage among cancer patients under the Affordable Care Act.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.