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ASCO: Medicaid reform necessary to improve access to quality cancer care
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Medicaid reform is vital in order to close coverage gaps and improve access to cancer prevention, screening and treatment for low-income individuals, according to a policy statement issued today by ASCO.
“As oncologists, we believe it is our responsibly to advocate for policies that expand access and improve the care of all people with cancer, regardless of financial means. We also believe that no individual diagnosed with cancer should be without insurance that guarantees access to high-quality cancer care delivered by a cancer care specialist,” ASCO President Peter Paul Yu, MD, FACP, FASCO, director of cancer research at Palo Alto Medical Foundation, said during a press conference. “Therefore, patients with cancer who have Medicaid should receive the same timely and high-quality cancer care as patients with private insurance.”
Peter Paul Yu
The receipt of screening and cancer stage at diagnosis are strongly associated with insurance status, Michael Halpern, MD, PhD, MPH, associate professor and section chair in the public health policy and management section at the University of Arizona Mel and Enid Zuckerman College of Public Health, said during the press conference.
Data suggest patients with cancer who enroll in Medicaid after their cancer diagnosis are twice as likely to have late-stage cancer, and three times more likely to have late-stage lung cancer, than those who enroll before diagnosis.
“This suggests that expanding Medicaid enrollment, and thereby permitting more individuals to enroll in Medicaid before they might develop cancer, can increase the likelihood of an earlier diagnosis,” said Halpern, co-author of the ASCO policy statement. “Given the large and growing Medicaid population, even small improvements in access to care could translate into substantial changes in health outcomes.”
Access to care
Due to disparities associated with insurance status, many of ASCO’s proposed reforms aim to improve access to cancer services among low-income individuals.
All states should expand Medicaid under the Affordable Care Act (ACA), according to the policy statement. Twenty-three states have not adopted Medicaid expansion, which the authors estimate affects the cancer care of at least 40,000 Americans.
Blase N. Polite
“We believe that coverage for cancer prevention, screening, diagnosis, treatment and survivorship care should be available to every American,” Blase N. Polite, MD, MPP, co-author of the ASCO policy statement, assistant professor of medicine at the University of Chicago and a
Further, Medicaid coverage benefits should be equalized among patients who enrolled before and after the ACA, and the policy statement re-establishes ASCO’s support of the 340B Drug Pricing Program’s reform to further incentivize care for this population regardless of treatment location.
The ASCO statement also supports oral cancer drug parity. Although most IV cancer therapies are covered under Medicaid, patients may have 20% co-pays for their oral therapies. The researchers note this cost, even when capped at 5% of a family’s income, can prohibit patients from receiving their cancer care.
Medicaid reimbursement is another area of concern. Currently, Medicaid reimburses 66 cents to every dollar Medicare pays, Polite said.
“Many physicians are not able to accept Medicaid patients since reimbursement rates fail to cover the cost of care, and the cross-subsidies from private insurers that physicians had used in the past to provide this care are being squeezed in a hyper-competitive health care marketplace,” Polite said. “Many Medicaid patients will not be able to find a physician or will resort to obtaining care in emergency rooms. This is especially problematic for patients with cancer, because a delay in treatment may have life-threatening consequences.”
Enhancing quality
ASCO also called for reforms society officials say would improve the quality of cancer care Medicaid enrollees receive.
Medical home designations should be expanded to include oncology practices, and all state Medicaid programs should report quality metrics, according to the statement.
Full coverage for cancer screening and genetic testing also are essential to improve the quality of care Medicaid beneficiaries receive, according to the report.
“Failure to cover genetic testing and risk-reducing surgeries and medications will perpetuate the health care disparities prevalent in the Medicaid population and ultimately cost the system more money,” Polite said.
Although the ACA requires health insurance providers to cover routine costs associated with clinical trials, this requirement did not extend to Medicaid patients. The ASCO report states this coverage, as well as coverage for out-of-state clinical trials, should be extended to Medicaid beneficiaries.
“Given the clear underrepresentation of racial and ethnic minority patients in clinical trials, this oversight places these patients, who are over-represented in the Medicaid population, at even greater disadvantage for clinical trial enrollment,” Polite said. “Not only does this prevent access to clinical trials for low-income Medicaid enrollees, but it also greatly impedes our ability to learn about important differences in response to and tolerance of potentially breakthrough treatments in the nation’s racially and ethnically diverse patient population.”
Disclosure: One researcher reports a consultant/advisory role with Genentech and honoraria from DySIS Medical.
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