Latest ACA Repeal Bill: Repercussions for Cancer Community?

Lifetime limits, increased costs, and other possible impacts on survivors and families

Congress returned to work this month after a brief summer recess and quickly revived its efforts to reform the health care system – with three very different proposals. The Policy Committee reviewed all three proposals during our September meeting. Since our meeting, the tide in Washington has shifted toward a plan to repeal and replace the Affordable Care Act (ACA), which would have significant impacts on the cancer community.

The bill at a glance

The repeal effort, initiated by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) and joined by Sens. Dean Heller (R-NV) and Ron Johnson (R-WI), retains many of the changes included in prior Senate and House repeal bills that would hamper cancer prevention and control efforts – including repealing the Prevention and Public Health Fund, blocking Planned Parenthood from receiving Medicaid reimbursements for cancer screenings and other health services, and capping funding for the Medicaid program through a per-capita gap or block grant.

In addition, the Graham-Cassidy-Heller-Johnson bill (known as “Graham-Cassidy”) would terminate Medicaid expansion, premium tax credits, cost-sharing subsidies, and other ACA-related funding sources beginning in 2020, and redistribute this money to states through a complicated formula. States would use these block grants to establish their own programs for providing health insurance coverage through a small menu of options outlined in the bill, such as creating a new system of premium subsidies and establishing state high-risk pools.

Under these block grants, people with pre-existing conditions could face lifetime limits and increased costs. The bill allows states receiving block grants to request waivers for ACA requirements that currently protect cancer patients and survivors from discrimination and significant financial risk. For example, states could opt out of essential health benefits – a set of 10 benefits that insurance plans are required to cover without annual or lifetime limits – and community rating, which prohibits insurers from charging more based on a patient’s past or current health status.

Graham-Cassidy does require states receiving waivers to provide “adequate and affordable” coverage for people with pre-existing conditions. But these terms remain undefined in the bill’s language, which increases risks for consumers. For example, a state high-risk pool may meet this requirement, but may or may not provide sufficient protection for cancer survivors.

The Senate intends to vote on Graham-Cassidy next week, as the they have only until September 30th to pass health care legislation using the “reconciliation” process that requires a simple majority, rather than the standard 60 votes. The non-partisan Congressional Budget Office has indicated it will not be able to provide a full analysis of the bill’s impacts on the deficit, health coverage, or health insurance premiums in time to meet that deadline.

For a more detailed breakdown of Graham-Cassidy and how it compares to the ACA and previous repeal bills, check out this comparison table.

Alternate proposals

In contrast to Graham-Cassidy, Govs. John Kasich (R-OH) and John Hickenlooper (R-CO) put forward a more limited set of policy proposals to stabilize the current health insurance marketplace. These proposals would continue to fund the cost-sharing reductions that lower out-of-pocket costs, support outreach and enrollment efforts, and provide greater flexibility to states through Section 1332 waivers. The Senate Health, Education, Labor, and Pensions (HELP) Committee held hearings this month to pursue a bipartisan stabilization package that considered similar proposals, although these efforts appear to be on hold while the Senate considers Graham-Cassidy.

Finally, Senate Democrats introduced a proposal to achieve universal health care coverage through a Medicare-for-All plan that would shift all Americans into the federal program over the course of four years. Sen. Bernie Sanders (I-VT), who introduced the bill along with 16 of his Democratic colleagues including Sen. Tammy Baldwin (D-WI), published a list of potential options to pay for the plan. Although the Medicare-for-All plan is unlikely to move forward, it represents a shift in the acceptability of universal health care among Democrats in Congress.

The bottom line for cancer control

Cancer patients and survivors need consistent, reliable access to affordable health insurance that offers comprehensive benefits and protects against the high costs of cancer care. Additionally, public health interventions that address cancer prevention and access to lifesaving screening services are essential to reducing the cancer burden in our state.

Supporting access to and expansion of these efforts are priorities of both the WI Comprehensive Cancer Control Plan 2015-2020 and the WI Cancer Council Policy Agenda and should be important considerations for WI Cancer Council members when reviewing all health reform efforts.