Abilene Reporter News: ACA cancer coverage creates 'winners and losers,' Neugebauer says

Mar 20, 2014 Issues: Health Care
March 20, 2014 10:26AM ET

By Brian Bethel Abilene Reporter-News, Texas

March 20--U.S. Rep. Randy Neugebauer toured Texas Oncology Center in Abilene as part of a stop here Wednesday, a visit he said was particularly relevant because many new plans under the Affordable Care Act do not cover certain cancer-specific health centers.

A prostate cancer survivor himself, the congressman said his visit with the facility's physicians and staff was to become a "better-educated policymaker," with the issue of cancer treatment and coverage looming large.

"There was a woman here in Abilene being treated for cancer, and when she got her new plan and found out her new plan wouldn't cover the doctor she was seeing," the congressman, whose district includes Abilene, offered as an example of "troubling" feedback from patients and others.

Such reflects a tendency, in his view, for government to pick "winners and losers" in the ongoing health care debate, something Neugebauer said must be stopped.

"Health care is a very personal thing to people, and we're kind of depersonalizing it by turning it over to the federal government," Neugebauer said after touring the facility. "I don't think that's a good idea."

A recent Associated Press survey of 19 nationally-recognized cancer centers found that only four had access through all of the insurance companies in their state exchange. MD Anderson Cancer Center, for example, noted that it was included in less than half of the plans in the Houston area.

With an increased focus on costs, many insurers have designed narrow networks of hospitals and doctors with government-subsidized private plans on the exchanges typically offering less choice than Medicare of employer plans.

By not including a top cancer center, an insurer can cut costs and can potentially shield itself from risk.

While largely limited to the new insurance exchanges, the issue could become a concern for Americans with job-based coverage if employers decide to turn toward more-narrow networks to shave costs.

Characterizing the federal government as in "cost-containment" mode, Neugebauer said the solution was not to ration health care, but to move toward a more "market-based health care system, where the patient and doctor are making those (important) decisions."

"We think that and empowering people, for example, to have health savings accounts, portability of their health care, some of those things, actually keep the government from making those decisions and hopefully keeps the government from having to make some of those decisions," he said.

Cancer centers themselves have experienced some "discomfort," said Abilene oncologist Jeff Messer, with offered insurance plans under the Affordable Care Act.

Texas Oncology participates in 27 plans across the state, two of which are local in Abilene, he said.

"But there were a lot of questions with a lot of the plans (as to) which physicians would be participating, what would be covered and the different drugs that we could or could not give," he said. "We had a lot of questions at the start, and there are still a lot of plans that we did not feel comfortable participating in."

Messer said the Texas Oncology Center has tried to help patients know which plans it is participating in.

"And we've tried to make sure that everybody got the care that they needed, regardless of which plan they were in or whether they were moved into an affordable care act plan or not," he said. "Especially the ones that were already established as our patients, we wanted to make sure that they got the care they needed."

The facility is a covered in-network facility for members of FirstCare, said Mike Martin, Communications Staff Specialist with the insurance provider, and is also covered an in-network provider on Blue Cross and Blue Shield of Texas' Blue Choice PPO plan, said Louis Adams, director of media and public relations.

The Affordable Care Act in many ways improves access to care for cancer, while creating issues such as narrowing networks.

Before reforms, a cancer diagnosis could make a patient uninsurable; now insurers now can't turn away people with health issues or charge them more.

Lifetime dollar limits on policies, once a financial trapdoor for cancer patients, have also been banned.

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The Associated Press contributed to this report.