Revised health care bill creates ‘huge unknown’ for oncology, hematology

The U.S. House of Representatives today narrowly approved legislation to overhaul the nation’s health care system, voting by a slim margin to replace the Affordable Care Act with new Republican-crafted legislation.

The House passed the American Health Care Act by a 217-213 vote. The measure required 216 votes to pass. Every Democrat voted against it.

“Today, we take the next step to repeal and replace Obamacare,” House Speaker Paul D. Ryan, R-Wisc., said.

Republicans initially planned a vote in March on the seventh anniversary of the signing of the Affordable Care Act, President Barack Obama’s signature health care plan. But the legislation was pulled after President Donald J. Trump and GOP leaders failed to secure enough votes to get it passed.

The legislation now moves to the Senate, where Republicans hold 52 of 100 seats.

However, the measure’s fate there is far from certain, according to Samuel M. Silver, MD, PhD, professor in the department of internal medicine and director of the Cancer Center Network at University of Michigan Cancer Center, as well as a HemOnc Today Editorial Board member.

“I doubt that the Senate will pass this bill as it stands,” Silver told HemOnc Today. “In talking with Senate officers earlier this week, the Republicans were very quiet on what they would do. They were just hoping it would never reach them.”

The replacement bill would eliminate the so-called individual mandate, which places a tax on people who do not purchase health care.

The measure also would give states the ability to seek waivers from two Affordable Care Act provisions — one that forces them to charge the same price to everyone regardless of health history, and another that requires insurers to cover essential health benefits. These services include mental health, maternity and hospital care.

Republicans have promoted the use of high-risk pools to subsidize insurance for patients with pre-existing conditions. Congress also added $8 billion over 5 years to the legislation to help offset insurance costs for these individuals.

“I have no idea whether the $8 billion ... will be enough to help individuals with pre-existing conditions cover insurance premiums,” Silver said. “The major loophole — allowing states to obtain waivers from the essential health benefits provision and community rating rules, which ban insurance companies from charging more for patients with pre-existing conditions, if the state creates high-risk pools — may hit patients with cancer and chronic hematologic disease particularly hard.”

The American Health Care Act also would phase out Medicaid expansion, and change the way in which the federal government would reimburse states for Medicaid expenses.

Silver added he is “definitely in fear” of what the legislation will mean for patients.

“We are entering a huge unknown, with a bill that hasn’t been scored, and there’s a reason that this didn’t wait for input from the [Congressional] Budget Office,” Silver said.

The American Health Care Act “would create a coverage patchwork” that would jeopardize the ability of millions of Americans to afford health coverage, Chris Hansen, president of the American Cancer Society Cancer Action Network, said in a statement.

“Allowing patients to be charged more for coverage based on their health status risks [makes] pre-existing condition protections virtually meaningless,” Hansen said. “A return to medical underwriting, combined with seriously weakened standards for what constitutes good coverage through the erosion of essential health benefits, sets up a situation whereby payers can cherry-pick their customers and leave patients with serious conditions like cancer with few if any affordable insurance options.”

Hansen described high-risk pools as an inadequate safety net that historically have allowed enrollees to be charged premiums up to 200% higher than average standard rates, created long waiting periods and established strict coverage limitations. He called those consequences “unacceptable” for patients with cancer and cancer survivors who require immediate treatment and consistent follow-up care.

“There is no denying that current law needs improvement; however, focusing on lower premiums for healthy people at the expense of the millions of Americans with pre-existing health conditions — including more than 16 million cancer survivors — is wrong,” Hansen said.

ASH President Kenneth C. Anderson, MD, director of Lebow Institute for Myeloma Therapeutics and Jerome Lipper Myeloma Center at Dana-Farber Cancer Institute, also expressed concerns about the potential impact of the American Health Care Act.

“We are deeply disappointed that the U.S. House of Representatives today passed a bill that would price the oldest and sickest Americans out of affordable health insurance coverage by waiving requirements for community rating and age rating, scaling back funding for Medicaid — a vital lifeline for many with blood diseases like sickle cell disease and hemophilia — and permitting states to opt out of requiring coverage for essential health benefits,” Anderson said. – by Gerard Gallagher and Mark Leiser