The ASBMT sent a strong message to the US Senate on Tuesday, May 9, 2017, urging senators to revise the American Health Care Act to ensure access to care. An excerpt of the letter can be found below.
The passage of the American Health Care Act (H.R. 1628) by the House of Representatives on May 4, 2017, must not be supported by the Senate. On behalf of the patients we treat, and our members themselves, we ask that you do not support any version of the legislation that removes access to care or creates discriminatory pricing practices for those individuals and families affected by illness.
The ASBMT takes issue with three significant changes in the current legislation:
- Allowing discriminatory pricing based on age or pre-existing condition: Blood cancers are physically devastating and are not predictable or avoidable based on personal health behaviors. Individuals who have received BMT/HCT for treatment of their blood cancer, or for treatment of another debilitating chronic disease such as sickle cell disease, should not be additionally punished by facing on-going challenges in securing health insurance coverage or having to pay multiples of the standard premium. Every individual who receives a BMT/HCT will subsequently be subject to these experience rating pricing increases when seeking insurance outside of a large employer setting. High risk pools will not be sufficient for meeting the needs of the 25% of the total United States population that has at least 1 pre-existing condition.
- Reduction of Medicaid funding: Reduction of Medicaid funding through limited block grants or the application of per-patient capitation will result in individuals being unable to pursue treatments that are initially cost-intensive but result in reduced disease and cost burden over time. Each year, approximately 1,600 pediatric patients receive BMT/HCT, many of which utilize Medicaid as a primary payer. Removing or reducing funding will result in a direct decrease in our ability to provide necessary care for these children. In the adult population, eliminating States' abilities to expand eligibility for Medicaid benefits in conjunction with removing the individual market subsidies will create an on-going barrier to accessing care for lower-income individuals.
- Allowing State discretion in the determination of Essential Health Benefits (EHB): The ten categories of care outlined as Essential Health Benefits are important in creating comprehensive and uniform health benefits for anyone seeking coverage. Most individuals are not in the position of knowing what services they may use in the future and should not be put in the position of purchasing a plan that may not cover life-saving therapies when needed. Allowing insurers to eliminate categories of services, such as oncology, will result in millions of individuals facing extraordinary out-of-pocket costs when are they are unexpectedly diagnosed with cancer. Of substantial additional concern are the annual and lifetime limit ties to the EHB plans – if states remove certain categories of care that affect oncology services, our blood cancer patients are then subject to annual and lifetime limits for the treatment of their illnesses. Finally, as self-funded employers are allowed to set their health care plans based on any state, allowing states to utilize waivers will create a situation in which the quality of insurance coverage rapidly erodes on a national level. It is unethical to create a marketplace that financially rewards efforts to offer fiscal protections only to those individuals with the lowest likelihood of needing to utilize health care services.
The costs of these illnesses will not disappear through modifications to the insurance provision system – individuals with acute hematologic malignancies who do not have access to affordable insurance will seek care in the emergency setting, likely resulting in high costs, for largely futile treatments, that will need to be absorbed elsewhere in the system. For those individuals who seek care but are not allowed to proceed to transplantation due to benefit exclusions, their unnecessary early mortality will have severe emotional and economic impacts on their immediate family units.
The ASBMT asks that all Senators vote against legislation that removes any of the discussed protections from Americans. We thank the Senators who have already expressed an intent to dismiss the American Health Care Act without further progress. We welcome questions regarding the impact of proposed health care legislation on the lives of the patients we serve.