of the implementation of the ACA will be occurring within the next four years. Mr. Weil pointed out that states will be instrumental in implementing many of the provisions in the legislation, including those to expand coverage and preventive health measures. Dr. Horton, Mr. Weil, and others then pointed out ways in which oncology stakeholders can monitor and influence the implementation of the ACA, especially in regard to determining the essential benefits that will have to be offered by qualified health insurance plans, the funding that is allocated to carry out some of its provisions, and gaps in coverage that need to be closed.
Dr. Horton noted the importance of defining the essential health benefits package of qualified plans. “What do you get as part of this minimal package or standardized package? How do you influence that at the federal level? That’s very important,” Dr. Horton said. Both she and Dr. Seffrin noted that such a package could specify palliative care, for example. Dr. Horton added that there is opportunity to inform and influence the National Prevention and Health Promotion Strategy that will be developed and its advisory council. Mr. Joseph Glick, founder of Expertool Software, suggested developing standards for risk-benefit analysis and cost calculation. These standards could perhaps be required on both the provider and the payor side and considered when determining essential benefits. “Neither the payors nor the providers are looking at cost-benefit in a standardized way,” he said.
“There is a lot of authorization language in [the ACA], but not many appropriations. So if Congress makes an effort to defund, most of these provisions are out of luck,” Dr. Horton pointed out. She added that the legislation could potentially be repealed or deemed unconstitutional at some point in the future. Dr. Seffrin doubted that the legislation would be repealed, although he acknowledged that it is likely to undergo changes and that “the important point is that we will be dealing with a new platform for delivery and we have to make sure that we build a better platform than what we have—that we get it right.”
Dr. Seffrin noted that the American Cancer Society is focusing more than three-quarters of its advocacy activities for the next four years on