Last week, the Supreme Court ruled 5-4 in favor of the Affordable Care Act (ACA), one of the most talked about laws in recent history. Many health care professionals, politicians, patients, and families alike are unsure how the ACA will directly affect the state of health care now and in the future.

If you download all 900 plus pages of the ACA online, it is possible you will gain no further clarity, only additional confusion. In an attempt to understand at least part of the ACA, I tried to focus on how it could potentially impact oncology patients. I must fully disclose that I am not a lawyer or a politician, so my interpretation of what is written in the ACA is strictly from a medical and pharmaceutical viewpoint.

No matter what type of cancer a patient may have, the associated costs of chemotherapy, hospital stays, outpatient medications, and doctors’ visits are an obvious deterrent for insurance companies when evaluating someone for coverage. One of the key features of the ACA is the mandate that insurance companies cannot deny patients coverage based on “predisposing conditions” such as cancer. This would in theory make insurance easier for cancer patients to attain. When a cancer patient eventually chooses a plan, the charge will not be higher because he or she is considered “sicker” that the average patient.

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It’s reasonable to consider that if a cancer patient has insurance, he or she could easily reach the plan limit after only several cycles of chemotherapy. The ACA protects against this by not allowing insurance companies to have yearly or lifetime limits on patients’ coverage. For patients who are enrolled in clinical trials, the ACA provides the option for health coverage that previously may not have been available in addition to whatever services are provided by the study.  

Although oncology is an extremely rewarding field, most people would agree that preventing cancer itself is a worthwhile goal. In many countries around the world, preventive health is emphasized more than it is in the United States. The ACA attempts to change this by providing full coverage for cancer screening tests such as colonoscopies for Medicare patients as well as including mandatory coverage of screening tests by insurance companies in new health plans purchased by patients. Other sections of the ACA promote the role of community-based preventive health programs and the primary care physician in educating patients. Several new preventive health “task forces” are to be established, which will be comprised of a diverse panel of health care professionals that will provide yearly reports and recommendations to the government. 

Many of the provisions discussed are in the early stages of being implemented, with the majority set to fully enact in 2014. As with many laws, only time will tell how the ACA will eventually affect health care in the United States. Unfortunately, oncology patients are not usually given the luxury of time when it comes to their health. There is also the constant question of how, exactly, the ACA will be paid for and if it will benefit patients in the most economical way. 

Regardless of the outcome, the ACA has managed to elevate the state of health care in the US to a more visible, national level. At the very minimum, hopefully this will generate discussions about how to improve the current system. And although debate and sharing of ideas is helpful on paper, it is more import to translate these discussions into actions and programs that truly help patients, especially those battling cancer.

Questions to Readers

  • Do you think the ACA will have an overall positive impact on oncology patients?
  • What are the potential issues you foresee with the ACA as it pertains to oncology patients?

Readers: We’d love to hear from you in the comments section below! If you have a case study or a more extended response to this subject, click here to submit an item for us to publish