For more than a decade, the National Breast Cancer Coalition (NBCC) has made access to quality health care for all a top legislative priority. In 2007, the NBCC grassroots Board of Directors approved a Framework for a Health Care System Guaranteeing Access to Quality Health Care for All which builds on Principles it adopted in 2003. Throughout the process of developing the Framework, NBCC applied its longstanding commitment to advancing evidence-based medicine and training consumers to strive towards systems change.

The Coalition supported passage of the Patient Protection and Affordable Care Act (PPACA), which marks an unprecedented step forward and reflects many of the principles and priorities NBCC adopted in our Framework. 

NBCC is pleased by a number of provisions in the legislation, including those that may expand access to meaningful, quality and affordable coverage provisions that attempt to tackle health care system costs, emphasize quality improvement in care delivery, provide for research in the comparative effectiveness of treatments and ensure that consumers and patients have a significant role in health care decision making at several junctures in the health care system. We believe these core elements are vitally important not only to women and men with and at risk for breast cancer, but to everyone. 

We know that the work to truly reform and transform our health care system is just beginning. The new health care reform law, while important, did not address many areas of concern and for those it did address many compromises were required along the way. The bill falls short in getting to the core issues and the original vision of our Framework, the goal of which was to achieve a well thought out and well designed health care system available to everyone. 

The bill does quite a bit to expand access to coverage to those who are uninsured or at risk of losing their coverage but is limited by the fact that it builds upon the existing employer-sponsored system. In addition, it remains to be seen whether coverage will be affordable for all.  Moreover, more progress must be made to control spiraling health care costs. Additionally, we must forge ahead on a system that is driven by quality improvement and founded on a delivery model of medical care and treatment based on science and evidence. 

There are a number of important changes taking place this year for women and men with breast cancer that NBCC is closely monitoring.

• Access to insurance coverage through temporary new high risk pools for people who have been denied coverage and are uninsured because they have a history of breast cancer.
• Private health insurance reforms that will eliminate pre-existing condition exclusions, require guaranteed issue, prohibit plan rescission except for fraud or intentional misrepresentation, and ban lifetime and restrict annual coverage limits.
• Health care information and support through state offices of consumer assistance and a federal web portal with relevant materials on coverage options and plan rules, as well as stronger consumer protections against health insurance plan abuses (including access to an external appeals process) and cost increases. 

The Road Ahead on Health Care Reform

As the implementation process moves forward, NBCC believes that trained patient advocates should play a key role in achieving this goal and in reforming our health care system. NBCC is closely following developments at the federal and state level. We look forward to our continued work to implement the many important provisions in the health care reform law and to make certain that the voices of those living with breast cancer are heard every step of the way.

Affordable, Accessible and Comprehensive Coverage -- An expansion of Medicaid to  133 percent of the federal poverty level and below, new private health insurance options for individuals and small businesses through health insurance exchanges, premium assistance through a sliding scale refundable tax credit for individuals between 100 and 400 percent of poverty to purchase qualified coverage. 

As the Secretary of HHS works to define what constitutes ‘qualified coverage’, NBCC will be pushing to ensure the benefits package guarantees coverage for care that is based on scientific evidence and is continuously reviewed and updated based on available best practices. Coverage should provide access to care that is medically effective, cost efficient, and most important, appropriate and truly affordable.

Private Health Insurance Reform and Access to Clinical Trials – No longer will insurance companies be allowed to discriminate based on gender and health status, nor will they be able to limit access to needed health care providers or services. They are also limited in charging differential rates based on age or where a person lives. Clinical trial participants are assured that routine costs will be covered and they do not risk losing their insurance coverage.   

Quality Improvement – NBCC strongly supports the research and analysis to determine the most effective and appropriate treatments for women and men with breast cancer through the Patient Centered Outcomes Research Institute. The development of quality measures thought a multi-stakeholder consensus process as well as testing of innovative payment and delivery models through the Center for Medicare and Medicaid Innovation is a good start toward integrating into our health care system a process by which tools and methods for measuring what is working so quality of care can be improved continuously.  

 Role for Educated Consumers – There are a number of areas that will have an impact for women with breast cancer and all consumers, where their voices should be heard. NBCC believes that educated health care consumers should play a role in all aspects of the health care system, including shaping what constitutes essential health insurance benefits, assisting in the development of quality measures, formulating comparative effectiveness research priorities, determining how information regarding coverage and treatment options should be presented and articulated to consumers and patients, and working with the scientific community to determine barriers and make recommendations regarding the successful translation of basic science. 

Medicaid Coverage for Breast and Cervical Cancer -- NBCC is also working during this transition to make sure that low-income, uninsured women diagnosed with breast or cervical cancer through the CDC screening program will continue to have access to Medicaid coverage for their treatment. All 50 states and the District of Columbia have elected to include this option in their Medicaid programs under the Breast and Cervical Cancer Treatment Act (P.L. 106-354), which NBCC fought for to protect vulnerable women afflicted with breast or cervical cancer.

Action Requested

NBCC believes that the new health care reform law is a good beginning. Many important provisions were not in the final reform package, including the establishment of a public option for health insurance. Additional polices are needed to ensure a system in which health insurance benefits are based on interventions proven to be efficacious, safe, cost-effective, and based on sound evidence, as part of a quality clinical trial or otherwise appropriately contributing to the evidence base. Our health care system will not successfully overcome the problems due to significant cost pressures until coverage is informed by the best available science.

NBCC is committed to fulfill the goal of guaranteed access to quality health care for all. For more information on this or NBCC’s other legislative priorities, please contact NBCC’s Government Relations Department at (202) 296-7477.