Impact of the Affordable Care Act on Cancer Care

Conquering the Cancer Care Continuum – Series Three: Fourth Issue
Lillie D. Shockney, RN, BS, MAS, ONN-CG
Editor-in-Chief, JONS; Program Director, AONN+; University Distinguished Service Professor of Breast Cancer, Administrative Director, The Johns Hopkins Breast Center; Director, John Hopkins Cancer Survivorship Programs; Professor of Surgery and Oncology, JHU School of Medicine; Co-Creator, Work Stride-Managing Cancer at Work

We have been hearing about the Affordable Care Act (ACA) for quite a while. However, many are still confused as to what this law is trying to accomplish and how it will benefit various populations of patients across the United States. This fourth issue of Conquering the Cancer Care Continuum™ provides readers with a comprehensive overview of the ACA as seen from the eyes of an oncology nurse, an insurance payer, and a pharmacist. I think these different viewpoints offer great value and will provide new insights into the potential impact of this legislation on both patients and healthcare professionals.

Everyone applauds the goals of improving access to care, developing more quality measures by payers (such as penalties for hospitals with high readmission rates), addressing the “doughnut hole,” and eliminating preexisting conditions, which have been a known barrier to care for a long time. As millions of people obtain insurance coverage, the healthcare system will be potentially flooded with new patients who may have neglected cancers that now are presented to us for evaluation and treatment. The law also provides for free screenings (for cancers that have methods for screening) with the goal of prevention or early detection. Once cancer is diagnosed, however, care is not necessarily going to be totally free. This remains an issue of confusion for individuals who are just now getting into an insurance program. What has been probably long overdue, and we hope will result in better quality of care, is a requirement that patients receive information that is linguistically and culturally sensitive for them.

Many parents who were planning on having an empty nest once their children finished college are now experiencing these young adults returning home after graduation. In some cases, these adult children are jobless. If they do find employment, there is a good chance that their jobs will not include insurance benefits. Therefore, the ACA also provides a means for “children” up to the age of 26 years to remain on their parents’ insurance plan.

As more oncology drugs are converted from intravenous to oral routes of administration, the need for access to these new drugs, education about how to self-administer them, and the need to adhere to the treatment plan as intended becomes crucial. We will all watch, some from a distance and others in the thick of things, as the ACA continues its work in providing insurance coverage with the hope that no one is without insurance benefits going forward.

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Palliative care has a serious identity problem. Seventy percent of Americans describe themselves as “not at all knowledgeable” about palliative care, and most healthcare professionals believe it is synonymous with end-of-life care.1 This perception is not far from current medical practice, because specialty palliative care—administered by clinicians with expertise in palliative medicine—is predominantly offered through hospice care or inpatient consultation only after life-prolonging treatment has failed. This means that the majority of patients who could benefit from palliative care are not receiving it until they are very close to death. To ensure that patients with metastatic breast cancer receive the best cancer care throughout their disease trajectory, palliative care should be initiated alongside standard oncology care, and it should be implemented early.
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“Establishing a Successful Navigation Program”: A JONS Exclusive Series
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October 2018 Vol 9, NO 10

How do you establish a successful navigation program? The answers are right here in this issue!

Last modified: June 6, 2018

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