The results of the 2016 election and the pending change in administration have triggered renewed focus on the future of healthcare. FORCE released an official statement on the election’s impact on the HBOC community and I hope to address additional issues here. The hereditary cancer community has good reason to be concerned. While the Affordable Care Act (ACA) isn’t perfect, it has components that are important to high-risk individuals and families.
Affordable Care Act and hereditary cancer
We are in the early stages of what will be an expansive health care debate, involving Medicare and Medicaid as well as the ACA. FORCE is closely monitoring the issues and will keep you abreast of changes that impact our community. These include, but are not limited to:
- Policies surrounding pre-existing conditions
- 100% coverage (no copay) for screening and preventive services including BRCA genetic counseling and testing, and screening mammograms for women over age 40
- Insurance coverage of oral contraceptives which have been shown to lower the risk for ovarian cancer and medications to lower breast cancer risk
- Allowing young adults to stay on their parents’ insurance plans (currently up to age 26)
- Coverage of routine care costs for patients who participate in clinical trials
- Lifetime caps on insurance coverage (abolished under ACA) and out-of-pocket healthcare expenditure caps
President-elect Trump’s website states, “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.” That said, the overarching view is that replacing ACA won’t happen overnight. ACA contains hundreds of provisions that can’t be changed or rescinded on a dime. An emerging strategy of “repeal and delay” is gaining momentum. It implies that the effective date of significant changes to ACA may be years away to allow for the phasing out of its numerous components. Still, it is possible to impair ACA without changing regulations or guidance. The administration could simply stop implementing or enforcing certain regulatory requirements, and there is little that could be done about it.
Steps you can take
Amid all of this uncertainty, what should the HBOC community be doing to ensure that we are in the best possible position to receive the quality and level of care we need? There are a few basic things you can do.
- If you haven’t already done so, get health insurance! The 2017 health plans already on the market will be unaffected. Currently, you cannot be denied coverage for a pre-existing condition such as a cancer diagnosis. Given the national guideline recommendations for increased screening, risk-reducing surgeries and increased likelihood of cancer diagnoses, members of the hereditary cancer community may wish to opt for a low-deductible plan whenever possible to avoid large out-of-pocket health care expenses.
- Schedule your preventive screenings while they are covered with no copay. This includes cancer genetic counseling and BRCA testing for women who meet the personal or family history criteria, and annual screening mammograms for women age 40 and over.
- Speak with your doctor about risk-reducing medications now. ACA’s contraceptive coverage requirement will likely be revoked. If you are taking oral contraceptives, fill your prescriptions on time and try to get a 90-day supply when possible. Currently the cost for the medications tamoxifen and raloxifene, which are used to reduce the risk of breast cancer, are also covered with no copay for certain high-risk women under the ACA.
- Reach out to your elected officials to let them know how important certain components of ACA are to you and your family. You can find contact info for current members of Congress at http://www.whoismyrepresentative.com/.
In summary, a number of legislative and regulatory changes that could significantly impact the U.S. health care system are on the horizon but details are in flux. We expect numerous twists and turns in the coming months, and the end results may look nothing like the current proposals. FORCE is working hard to track these issues and will advocate for the interests of the hereditary cancer community. Stay tuned for updates!
FORCE is only able to do the important work we do with the support of people and stakeholders like you. Please consider a donation to FORCE to help us continue these important advocacy efforts!
Tags: brca, BRCA 1, BRCA1, BRCA2, breast cancer early detection, breast cancer prevention, cancer prevention, gene testing, Genetic counseling, HBOC, ovarian cancer, prophylactic surgery, screening and prevention, survivor, USPSTF, young survivor