OBAMA HEALTH PLAN IS ALIVE AND KICKING 

June 29, 2012 — Although the US Supreme Court's recent decisionlargely upheld the constitutionality of the Affordable Care Act (ACA), oncologists are already debating its ramifications.

Although some applaud the comprehensive cradle-to-grave approach, others have concerns regarding its implementation and effect on the healthcare system.

The wide-ranging legislation has many cancer-specific or cancer-related provisions, notes the American Society of Clinical Oncology in a press statement. These include:

• Preventive screening services such as mammograms and colonoscopies will be provided at no cost to patients.
• Health plans on the individual market must offer essential benefits needed to treat a serious condition such as cancer.
• Lifetime caps on insurance will be eliminated, allowing repeated courses of therapy.
• Insurance plans will not be able to exclude individuals with cancer or a history of cancer.
• Insurance companies will be prohibited from unfairly revoking coverage when an individual becomes ill.
• Private insurance must cover patients with cancer and other life-threatening conditions whose best option is enrolment in a clinical trial.

The influential American Cancer Society (ACS) applauded the judicial ruling.

"The ruling is a victory for people with cancer and their families nationwide, who for decades have been denied health coverage, charged far more than they can afford for lifesaving care and forced to spend their life savings on necessary treatment, simply because they have a pre-existing condition," stated John R Seffrin, PhD, chief executive officer of the ACS and its Action Network (ACS CAN), in a press statement.

However, Medscape Medical News found a mixed reaction among a couple of medical oncologists who were asked for comment.

"My general impression is that this is great news for most cancer patients and for our entire healthcare system. It is, in fact, long overdue," Gary H. Lyman, MD, MPH, told Medscape Medical News. He is professor of medicine and director of the Comparative Effectiveness and Outcomes Research program at Duke University Cancer Institute, Durham, North Carolina.

Dr. Lyman also said that although the ACA is far from perfect, it contains many features that will protect current and future patients from the inequities in our healthcare system.

"Many of the benefits are yet to be realized but hold great promise for all of us and the next generation of Americans," he added.

However, another clinician expressed serious concerns regarding the manner in which ACA will be implemented.

"Healthcare is a precious and valuable commodity: each person has to take responsibility at a high level to ensure that they and their families have it, just like housing and food. The government can and should provide basic care for those unable to pay, but there are major limits to what we can ask government to do and pay for," Nicholas J. Vogelzang, MD, from the Comprehensive Cancer Centers of Nevada in Las Vegas, told Medscape Medical News, noting that the suggested cradle-to-grave type of coverage will bankrupt our country, as he says it is doing in Spain and Greece.

Refocusing healthcare aims on disease prevention, which is also an ACA premise, may be key.

"We need an understanding that good health is earned to a large extent through healthy living that includes diet control, avoiding toxins, exercising, and having regular checkups," Dr. Vogelzang stated, adding that smoking, for example, should be banned.

Although the ACS is concerned that ACA may limit expansion of quality coverage only to some of the most vulnerable citizens, some oncologists and patients worry about the effect of all-inclusive health insurance.

"We hope that ultimately, the decision will ensure access to quality health coverage through Medicaid for all low-income and disabled Americans with cancer or at risk for cancer. For many hard-working Americans who have lost their health insurance because they are too ill to work or who have exhausted their savings, Medicaid coverage will provide critical access to proven preventive services and lifesaving treatments," Dr. Seffrin said.

However, allowing more patients into the system may lead to serious financial and health-related costs, suggested Dr. Vogelzang.

"My experience is that such patients are already neglecting their health (for any number of reasons, many of which are not related to cost). Therefore, they often have advanced and neglected cancer, and their entry into the 'system' will initially cause a major cost burden that will hopefully drop in the long term," Dr. Vogelzang said.

"Many of my current patients are very worried that they will see longer wait times, less access to their oncologists, more drug shortages, and more restrictions on the newest most expensive drugs," he added.