The Patient Protection and Affordable Care Act (ACA) is transforming the health system across the country. The ACA aims to increase insurance coverage, which should improve access to preventive services and cancer treatment. Health insurance exchanges have been established to help individuals and businesses gain access to health insurance plans. Many low-income individuals are now eligible for subsidized insurance, which can help them gain coverage and reduce disparities.
ACA provisions related to cancer control include:
- High-risk pools have been established in every state to provide coverage for the uninsured, providing immediate access to coverage for people in every state who have been uninsured for six months or more and have cancer or another pre-existing condition.
- The Affordable Care Act has closed the Medicare gap in prescription drug coverage.
- Health plans are prohibited from denying coverage to persons with pre-existing conditions, such as cancer.
- Health plans are banned from setting lifetime dollar limits on coverage, ensuring that people with cancer have access to needed care throughout their lifetimes. Annual dollar limits have also been eliminated.
- Health insurers are barred from dropping people from coverage when they get sick.
- Coverage is guaranteed and out-of-pocket costs are eliminated in new insurance plans for proven preventive and screening services, giving people ccess to lifesaving screenings for breast, cervical and colorectal cancer.
- Insurers are prohibited from dropping or limiting coverage for individuals participating in clinical trials.
- Medicaid is required to cover, without cost sharing, counseling and pharmacotherapy services for smoking cessation for pregnant women.
- All federally-funded health care or public health programs, activities, or surveys must collect and report standardized data on race, ethnicity, sex, primary language and disability status.
- A National Coordinator for Health Information Technology will develop national standards for management of the data collected
CONNECTICUT’S HEALTH CARE COSTS
The rollout of the Affordable Care Act in Connecticut marks the beginning of a period of change in the financial underpinning of health insurance for individuals and employers. Monitoring its implementation will take center stage as an emerging issue during the period covered by the Connecticut Cancer Plan, 2014-2017. Connecticut’s health exchange is known as Access Health CT.
The Partnership plans to monitor the prescribed elements of covered cancer control addressed in the Affordable Care Act, including prevention and screening as well as the identification of gaps in the continuum of care.
“I have had the opportunity to build stronger professional relationships with people and agencies with like goals. I have used reports produced by the CT Cancer Partnership in Federal reporting and to guide future work plans.
The CT Cancer Plan has helped me glean facts to educate youth and tobacco merchants about the health effects of tobacco use, the burden of providing health services for tobacco users, and the benefits of prevention to improve the general health of Connecticut residents.”
Primary Prevention Services Coordinator
Department of Mental Health & Addiction Services Hartford
Four-year Partnership member
“Being on the Advocacy Committee gives me an understanding of the importance of political issues in achieving the objectives of our Cancer Plan.”
National Alliance of State Prostate
Six-year Partnership member
MEDICAL HOME MODEL
The Affordable Care Act supports implementation of the medical home model of care, which aims to reduce costs while improving quality and efficiency through an innovative approach to delivering comprehensive patient-centered preventive and primary care. The medical home relies on a team of providers-such as physicians, nurses, nutritionists, pharmacists and social workers-to meet a patient’s health care needs. One project has received federal funding “to implement and test a medical home model of care delivery for newly diagnosed or relapsed Medicare and Medicaid beneficiaries and commercially insured patients with breast, lung, or colorectal cancer.”