The Changing Healthcare Landscape

beforehealthcarereform-v2This week, we're exploring a big question around childhood cancer survivors and healthcare:  How can we do better? Don't get us wrong: We're so pleased and proud that childhood cancer survivors now have greater access to quality care and affordable insurance than ever before. Because of the Affordable Care Act (ACA), no survivor will ever again be denied coverage because of their cancer history or told they've reached their lifetime coverage limit. An article this month in the Journal of Clinical Oncology outlines these and other provisions of the ACA that benefit survivors of childhood cancer. The chart below, courtesy of the JCO study authors, shows the 5 most relevant ACA provisions:

aca-implications-table3

These provisions are crucial for the long-term health and well-being of our nation's 360,000 survivors of childhood cancer. But our young survivors need more:

  1. Overcoming Benefit Limitations: The Affordable Care Act requires a limited set of "essential health benefits" (EHBs) be fully covered by insurance companies. But childhood cancer survivors already have a set of recommended tests as laid out in the Children's Oncology Group's Long-Term Follow-Up Guidelines. These screenings are specially suited to match a patient's cancer history and treatment protocol, and many of them are unlikely to be included in the EHBs. The study's authors note that this means "clinicians will need to be mindful of potential plan benefit limitations and advocate for their patients to be reimbursed for procedures performed according to COG screening guidelines."
  2. Overcoming the Knowledge Gap: Another recent study found that two-thirds of general internists surveyed reported feeling "uncomfortable" caring for childhood cancer survivors, with 90% reporting unfamiliarity with the above-mentioned COG screening guidelines. In order for doctors to provide and advocate for the best care and coverage for their patients under the new healthcare law, they must have better knowledge of the care required for this patient population. President Obama's 2015 Budget plan calls for $14.6 billion in the next ten years to expand the ranks of primary care providers, but we need to make sure both new and established doctors are educated, equipped, and empowered to care for the unique health needs of the growing population of childhood cancer survivors.

The healthcare law is changing the landscape for childhood cancer survivors in ways that we are just beginning to understand. In the coming months and years, more studies will be needed to evaluate the ways the ACA is improving the health of childhood cancer survivors - and the gaps that still exist.

As the individual mandate goes into full effect, we'll be watching closely to see if both coverage for care and access to care are being adequately provided for childhood cancer survivors. But we need your help to do this well:  If you've signed up for coverage in the marketplace, please tell us about your experience.