2-10-12 Monthly Advocacy Update

Federal Update        

Yesterday the administration published the final regulation for the Summary of Benefits and Coverage (SBC), which will put cancer patients, survivors and their families in a far better position to make important decisions about their health coverage. Under the Affordable Care Act, insurers are required to provide consumers a brief, straightforward summary of benefits, including real-world examples.  ACS CAN views the provision as a fundamental component of the fourth "A" - administrative simplicity -- in the Society and ACS CAN's four "A's" of meaningful health coverage. 

The final rule is a very good step forward in helping consumers. Beginning September 23, 2012, all plans-individual and group markets and self-insured plans-will be required to provide a standardized document to all plan participants and applicants for coverage. For the first time, consumers will be able to obtain basic information about health plans in concise, comprehensible language. In addition, there will be two examples that allow for direct comparisons between plans. The initial examples are for maternity and diabetes care, but more examples are expected to be included over the next few years, including one for breast cancer.

The final rule is a great victory given grave concerns over the past few weeks that the rule might be weakened considerably. ACS CAN and other consumer groups fought hard for a strong rule, sending a letter to the White House signed by the chief executive officers of ACS CAN, the American Heart Association, the American Diabetes Association, Consumers Union, and AARP. We have been told that the letter had a big impact and contributed to consumer-oriented improvements in the final regulation. ACS CAN also issued a grassroots alert that resulted in hundreds of messages being sent to the White House that made our position clear.

State Update 

Even as many states are still working on legislation to establish health insurance exchanges, all states will soon need to focus on creating  a list of essential health benefits (EHB), now that the Department of Health and Human Services (HHS) has empowered states to choose a benchmark plan to define a benefits package. Starting January 1, 2014, all health insurance plans sold in the individual and small group (employers of 100 or less) markets must provide benefits in 10 broad categories as detailed in the Affordable Care Act. The law, however, does not detail the level of coverage for each of the categories. States must choose from among 10 existing plans at the state or federal level to determine the EHB package that will apply to them. Options include:

a) The three largest federal employee plans;

b) The three largest plans in a state's small group market;

c) The three largest state employee plans; and, 

d) The state's largest HMO plan.

States must decide on a benchmark plan in the third quarter of this year, and that benefit level will be used in  2014 and 2015. States that do not choose a plan will default to the largest small group plan in the state.

ACS CAN is currently developing materials for the field that will assist government relations staff in understanding the options available in their state from a cancer perspective, and how to best advocate for the plan that is deemed best for consumers and cancer patients. Reviewing the plan options will be difficult because of the lack of transparency in the process and the complexity of the documents available. ACS CAN is considering all available options to make this process as easy as possible for government relations staff in the states.

Reports and Polling

New Study: Access to Health Care Affected by Income, Not Coverage Alone

Nearly three out of every five U.S. adults earning less than 133 percent of the federal poverty level did not have health insurance at some point in 2011, according to a new report from the Commonwealth Fund. Furthermore, insured adults with incomes under 250 percent of the federal poverty level are significantly more likely to visit emergency rooms for non-urgent care than insured adults with incomes at or above that level. The study's outcomes suggest that while the Affordable Care Act will significantly narrow inequities related to health care coverage, improvements to primary care will still be necessary to ensure that low-income individuals can see medical providers and receive prescriptions in a timely way.

As always, thank you for all you do every day to support laws and policies that help cancer patients and their families.

Chris Hansen | President

ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.