Three Experts Weigh In on the Health-care Reform Legislation

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In light of the Supreme Court ruling, The ASCO Post asked three nationally regarded experts about how the Affordable Care Act will affect the practice of oncology.

Ezekiel J. Emanuel, MD, PhD, Professor and Vice Provost for Global Initiatives, University of Pennsylvania: This is an overwhelmingly positive outcome. We’ve spent 2 years wondering if the Affordable Care Act would be hampered by a legal challenge, and during that time some states waited before establishing their health-care exchanges, a main component of the law. Now it’s full steam ahead; the task we now face is implementation.

As far as oncology is concerned, providers are definitely going to be required to justify the value of their treatments and interventions, which should be embraced as a good thing, both for the system and our patients. After all, we pride ourselves as being a data-driven specialty, so if the data do not support an intervention, oncologists should not be doing it. We need to control costs, but you cannot turn a $2.8 trillion ship around overnight. I began campaigning for cost-effective oncology almost a decade ago; now the Affordable Care Act will help catalyze that effort.

Ted Okon, Executive Director, Community Oncology Alliance (COA): We’ll begin to examine all parts of the law germane to oncology as it unfolds. There are facets of the Affordable Care Act that benefit patients with cancer. A lot of uncertainty remains, but COA remains cautiously optimistic.

That said, there are problematic parts of the law that will definitely have a negative impact on the delivery of cancer care. Chief among them is the establishment of the independent payment advisory board (IPAB), which is a terrible piece of public policy.

IPAB gives huge discretion over Medicare reimbursement to a board of 15 advisors who are not accountable to anyone but are essentially supported by the Executive Branch of the government. When certain targeted spending numbers are reached, IPAB will take a broad ax to cut provider payments. The oncology community has already been hampered by cuts to reimbursement, so IPAB could continue the assault on the community.

Mathew Farber, MA, Director, Provider Economics and Public Policy, Association of Community Cancer Centers (ACCC): We’re glad that the Affordable Care Act survived the legal challenge in that many of the insurance reforms in the bill (such as the preexisting conditions section) help ensure access to care for patients with cancer. But it is a massive bill, so we’re currently educating our members on what each aspect of the legislation means for their cancer care services moving forward.

The big questions for ACCC are about how the Medicaid expansion is going to affect our member institutions. For instance, will some states opt out of the expansion for budgetary reasons? After all, it will have a huge price tag. So we need to see how this unfolds, and then respond with the information that helps our members care for their patients.

Another issue with more Medicaid patients entering the system is reimbursement. Our members already have challenging margins, so how will they deal with more Medicaid, which pays less and takes a long time to process? Although we are optimistic about the Affordable Care Act, we need to analyze how the provisions go from paper to practice. ■

Disclosure: Dr. Emanuel, Mr. Okon, and Mr. Farber reported no potential conflicts of interest.

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