Mr. Weil noted that although many of the provisions of the legislation will be implemented by 2014, some will not be in effect until as late as 2021, so there is still the opportunity to engage in workshops or studies that would influence the implementation of the bill. “Think about the time line that health reform is under. Some things are already out of the chute, and other things have yet to happen,” Mr. Weil said. Dr. Ferrell added that “health reform is more than just shifting of the funding…. In each of these provisions there is also an opportunity for us to really rethink the quality of care that’s delivered to real patients and families.”

Coverage Gaps

There will be several potential gaps in coverage with the advent of the ACA that Dr. Horton pointed out. She noted that the National Breast and Cervical Cancer Early Detection program and similar existing programs will expire within several years. It is not clear if the ACA will be sufficient to extend the preventive care those programs provide in an environment of tight discretionary dollars. “How do you begin to make the case to continue other programs like this as needed?” Dr. Horton asked.

While the ACA provides coverage of routine care costs related to clinical trial participation for state-regulated insurance and employer-sponsored plans, this provision is not applicable to Medicaid, although states may cover the routine costs associated with clinical trial participation through their own funding initiatives (Rosenbaum et al., in press). Dr. John Hohneker, senior vice president and head, Global Development and Integrated Hospital Care at Novartis Pharma AG, asked how to achieve uniform implementation of the legislation in this regard at the state level so that “cancer patients in California are treated the same as cancer patients in Iowa,” he said. Mr. Weil agreed that attention to this is warranted.

Dr. Horton also pointed out that 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, the ACA doesn’t require coverage of preventive screening benefits for adults in “traditional” Medicaid eligibility categories, which tends to comprise the poorest women who are caretakers of minor children and disabled nonelderly adults, creating a gap in coverage for this vulnerable population.

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