ACA Update: New Challenges for Cancer Patients

New challenges to the Affordable Care Act (ACA) may affect the cost and availability of health insurance for cancer patients and survivors.

State and federal officials have offered several proposals that experts say could increase costs for people with pre-existing conditions, as healthy consumers leave ACA marketplaces in favor of cheaper plans with fewer benefits and protections. One example is a rule the Trump Administration proposed in February that would expand access to short-term health plans. Consumers who select these plans could be vulnerable to large bills or loss of coverage if they become sick, and both internal and external analyses show the rule could significantly raise premiums in the ACA marketplaces. After a huge outpouring of public comments by health groups and others in response to the rule, the comment period closed in April and a final rule could be released soon.

In mid-April, the Administration finalized an annual rule making updates to the ACA marketplaces. Among other changes, the rule gives states more flexibility when choosing which benefits they include in their “essential health benefits” package for plans beginning in 2020. Although any new benefit packages still must meet certain requirements, patient and health care advocates are concerned this rule change could ultimately lead to health plans with fewer benefits. The rule also made changes to the navigator program, which when added to funding concerns, could mean less in-person enrollment assistance from organizations like Covering Wisconsin again this year.

Finally, last week, the Justice Department announced it would not fight a lawsuit being brought by Wisconsin and several other states arguing that the ACA is unconstitutional after the individual mandate penalty was zeroed out in the tax bill. Currently, the ACA protects cancer survivors and others with pre-existing conditions from being charged more or denied coverage due to their health. In agreeing with the states, the DOJ has argued these popular protections should be invalidated. While the case is far from decided, insurers and experts predict that this additional uncertainty in the insurance market could mean higher prices or fewer options for people in the ACA marketplaces in the meantime.

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