In the regulatory update in our March 13 issue of Part B News, Ann Marie Edwards, CEO of Alliance Cancer Specialists PC in Philadelphia, talks about the hardship the Obamacare “grace period” puts on her practice and how she hopes the Republican repeal-and-replace bill, the American Health Care Act, will solve it. To follow are some of her further thoughts on that bill.
"There are things that aren’t addressed that Trump has spoken about and should be included. I would expect to see these in the future before legislation is finalized. For example, insurance sales across state lines, which will probably be key to affordability, and the expansion of the HSAs [health savings accounts] – the current bill doesn’t define the limitations on contributions, how long funds can be retained or what they can be used for. The reform also doesn’t address other key issues that have been discussed regarding reforming the overall cost of insurance coverage or prescription drugs."
"With some of the ACA metallic level plans, there can be a real gap between the cost of care and coverage. These cost shares can be 30%, 40% and even 50% of the cost of these chemotherapy and biologic drugs. Patients on subsidized health care most often can’t afford these benefits when faced with a disease such as cancer. … I know the metallic plan requirements are supposed to be eliminated, and I would hope that when insurers have the ability to offer varying levels that have not been mandated by the government, they can design plans that are more affordable and give better coverage consistent with the commercial market for health insurance."
"Alliance Cancer Specialists is also a purchaser impacted by the ACA. One of those things that will be eliminated with AHCA is the mandate to offer coverage. Right now, a large employer (50+ employees) must offer coverage to employees working 30 hours or more. That has created issues as we previously defined full-time employees as those working 40 hours or more. There is also the reporting requirement for employers to report coverage eligibility and expenses for every employee on a 1095C form. The software to do that reporting alone costs us $2,000 a year, which does not add value to the company or the employees. One good thing is that [with the end of the employer mandate], those unnecessary reporting requirements will go away."
"Under the AHCA the creation of the Patient and States Stability Funds will allow individual states to design programs based on their unique needs. This will create an opportunity to innovate in state programs by encouraging population health management and programs supporting social determinants in health care. These determinants -- such as nutrition, caregiver support and affordability of medications -- are key indicators in patient outcomes when facing a significant diagnosis such as cancer."
"The Affordable Care Act provides expanded coverage but, without being addressed thoroughly and thoughtfully, is not sustainable in its current form. Reform is needed and the AHCA seems like a great start that continues the important access to care provided by retaining dependent care coverage until age 26 and disallowing denials of coverage for pre-existing conditions."