Implications of the Affordable Care Act for Adult Survivors of Childhood Cancer

March 2014, Vol 5, No 2
Jayson Slotnik, JD, MPH
Managing Partner
Health Policy Strategies, Inc.
Bethesda, MD

Among adult survivors of childhood cancer, the lack of health insurance is a major obstacle to obtaining the recommended follow-up care. The goal of the Patient Protection and Affordable Care Act (ACA) enacted in 2010 was to broaden insurance coverage for all Americans. A new commentary by Mueller and several health policy experts addressed the questions regarding how several provisions in the ACA could help adult survivors of childhood cancers overcome insurance-based barriers to receiving the recommended follow-up care for patients with cancer (Mueller EL, et al. J Clin Oncol. 2014;32:615-617).

The first provision in the ACA mandates that insurance coverage cannot be denied or canceled because of a preexisting condition; under this provision, survivors of childhood cancers can continue to receive the recommended follow-up care, even in remission. The second provision states that individuals can be covered by their parents’ insurance up to age 26 years. Under the third provision, states may choose to raise the Medicaid minimum eligibility requirement to 133% of the federal poverty level, allowing low-income adults without children to be ensured Medicaid coverage without a federal waiver. The fourth provision states that insurance companies cannot set annual or lifetime coverage limits for medical services. To increase the affordability of health insurance, the fifth and final provision permits states to purchase health insurance with subsidies, for eligible individuals, based on income and family size.

Because the ACA supports insurance coverage (with no out-of-pocket costs) of only those procedures set forth by the US Preventive Services Task Force, Mueller and colleagues point out that some screening tests related to an individual’s previous cancer or cancer-related treatment history may not be covered by all plans. In these instances, clinicians should be aware of the potential respective health plan limitations.

Although the ACA may alleviate some of the financial burden associated with healthcare insurance, the authors contend that there are survivors of childhood cancers who may not opt for health insurance coverage. However, these individuals may end up paying a penalty, because the ACA now requires all individuals to maintain a minimum amount of health coverage monthly.

The authors suggest several topics related to adult survivors of childhood cancers that warrant further investigation, including the ability to obtain and maintain health insurance, measures of underinsurance, and evaluation of access to care. Furthermore, the authors stated that the success of the ACA is partly dependent on clinicians counseling and encouraging their patients to receive follow-up care, especially for patients with a history of cancer.

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