AFFORDABLE CARE ACT (ACA)
The main goals of the ACA are to provide broad health insurance coverage and improve the fairness, quality, and affordability of that coverage, improve healthcare value and efficiency, strengthen primary care access, and invest in public health. The ACA establishes a health plan exchange marketplace for insurance products that meet certain federal and state standards, which are called qualified health benefit plans. These plans are required to cover “essential benefits,” which have yet to be fully defined.
The stipulations of the ACA that are especially relevant to cancer patients and providers include the following:
Children up to age 26 can enroll on a parent’s plan, and exclusion based on preexisting conditions is prohibited for children, effective July 1, 2010.
Adults with preexisting conditions, beginning in 2014, cannot be denied coverage or be forced to pay more based on their health status or gender.
Insurers cannot drop coverage because of an individual’s participation in a clinical trial. The legislation prohibits the denial of coverage of routine care costs of participants in certain clinical trials, including FDA-approved drug trials and federally funded clinical trials that treat cancer or other life-threatening diseases. However as currently devised, it does not mandate coverage of routine care costs of Medicaid participants in clinical trials, although that is an option for states, if they are willing to fund it.
Medicaid will be expanded to cover all nonelderly, nondisabled citizens and legal U.S. residents with family incomes below 133 percent of the poverty level and will provide preventive care for those individuals. However, coverage of preventive screening