In a 64-page opinion, the court held “that the minimum coverage provision is a valid exercise of legislative power by Congress under the Commerce Clause.” Read the court’s decision.

Judge Jeffrey Sutton is the first Republican-nominated judge to rule in favor of upholding the law. In his concurring opinion, Judge Sutton wrote that while the plaintiffs challenging the law failed to make their case for now the ruling doesn’t prevent individuals from initiating new challenges to the Affordable Care Act after the insurance requirement goes into effect and it becomes clear how the law affects particular individuals.

The court’s decision today upheld a district-court ruling that also found the law constitutional. There are two other cases challenging the Affordable Care Act pending before different federal appeals court.

The members appointed to the Methodology Committee are:

• Naomi Aronson, PhD, Executive Director, Blue Cross and Blue Shield Association Technology Evaluation Center.
• Ethan Basch, MD, MSc, medical oncologist and health services researcher, Department of Medicine and Department of Epidemiology, Memorial Sloan-Kettering Cancer Center.
• Alfred Berg, MD, MPH, Professor, Department of Family Medicine, University of Washington.
• David Flum, MD, MPH, Professor, Department of Surgery and Adjunct Professor, Department of Health Services, University of Washington Schools of Medicine and Public Health; Attending physician, General Surgery, University of Washington Medical Center.
• Sherine Gabriel, MD, MSc, Professor of Medicine and of Epidemiology, and the William J. and Charles H. Mayo Professor, Mayo Clinic.
• Steven Goodman, MD, PhD, Professor of Oncology, of Pediatrics, of Epidemiology and of Biostatistics, Johns Hopkins School of Medicine and Bloomberg School of Public Health.
• Mark Helfand, MD, MS, MPH, Professor of Medicine and of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University; Staff physician, Portland VA Medical Center.
• John Ioannidis, MD, DSc, the C.F. Rehnborg Professor in Disease Prevention, Professor of Medicine and Director, Stanford Prevention Research Center, Stanford University School of Medicine.
• David Meltzer, MD, PhD,  Director, Center for Health and the Social Sciences, Chief of the Section of Hospital Medicine, and Associate Professor, Department of Medicine, Department of Economics, and Graduate School of Public Policy Studies, University of Chicago.
• Brian Mittman, PhD, Director, VA Center for Implementation Practice and Research Support, Department of Veterans Affairs Greater Los Angeles Healthcare System.
• Robin Newhouse, PhD, RN, Assistant Dean, Doctor of Nursing Practice Program and Associate Professor, Organizational Systems and Adult Health, University of Maryland School of Nursing.
• Sharon-Lise Normand, MSc, PhD, Professor of Health Care Policy, Harvard Medical School and Professor of Biostatistics, Harvard School of Public Health.
• Sebastian Schneeweiss, MD, ScD, Associate Professor, Department of Medicine, Harvard Medical School and Associate Professor, Department of Epidemiology, Harvard School of Public Health;  Vice Chief and Director,  Drug Evaluation and Outcomes Research, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital.
• Mary Tinetti, MD, Professor of Medicine, Epidemiology, and Public Health, Division of Geriatrics, Yale University School of Medicine;  Director, Program on Aging, Yale University School of Medicine.
• Clyde Yancy, MD, MSc, Chief, Cardiology, Northwestern University Feinberg School of Medicine; Associate Director, The Bluhm Cardiovascular Institute, Northwestern Memorial Hospital.

“The Methodology Committee has the responsibility of helping PCORI develop and update methodological standards and guidance for comparative clinical effectiveness research.  The  men and women named today bring impressive credentials and experience to this important task,” Dodaro said.

In addition to the 15 members appointed today, the Director of the Agency for Healthcare Research and Quality and the Director of the National Institutes of Health, or their designees, will also serve on the committee.

Under the provisions of the Affordable Care Act, PCORI is tasked with assisting patients, clinicians, purchasers, and policymakers in making informed health decisions by providing quality, relevant evidence on how best to prevent, diagnose, treat, and monitor diseases and other health conditions.

Ellen Sigal

Today, the Government Accountability Office (GAO), announced the appointment of 19 members to the Board of Governors for the new Patient-Centered Outcomes Research Institute (PCORI or the Institute). The Institute was created by the Affordable Care Act to set comparative effectiveness research priorities, establish research methods, and communicate research results to the public.

The PCORI Board appointed today includes three patient and consumer representatives. One of those representatives is Ellen Sigal, PhD, Chairperson and founder of Friends of Cancer Research, a cancer research think tank and advocacy organization. Ms. Sigal’s term on the Board will expire in September 2016.

The Colorectal Cancer Coalition is a member of Friends of Cancer Research and congratulates Ms. Sigal on her appointment. Nancy Roach, founder and Colorectal Cancer Coalition Board Chair released a statement congratulating Ms. Sigal on her appointment:

“Ellen’s engagement in both the policy and science of research make her an excellent choice. The Colorectal Cancer Coalition looks forward to working with the Board in advancing comparative effectiveness research for the benefit of patients.”

Gene Dodaro, Acting Comptroller General of the United States and head of the GAO announced the appointments.

“The research to be developed by PCORI has the potential to improve the quality of health care for people across the nation,” Dodaro said. “This outstanding group of individuals brings an impressive range of knowledge, expertise and professional experience to this important initiative.”

Click here for a list of the other Board members appointed today.

About the Patient-Centered Outcomes Research Institute

The Affordable Care Act established PCORI as a non-profit organization to help patients, payers, physicians and other stakeholders make medical decisions by providing them with evidence-based research.

The Institute Will Help Identify, Fund Research Initiatives

Institute Is Likely to Influence Coverage Decisions

The Institute will carry out a variety of functions, including:

• identifying national priorities for research by taking into account factors of disease incidence, prevalence and burden in the United States;
• establishing a 15-member methodology committee to develop and periodically update scientifically based methodological standards for research conducted through the institute;
• funding and conducting research with federal agencies, academic centers and institutions, and other entities;
• disseminating findings to all stakeholders in an understandable manner; and
• ensuring transparency by requiring public input.

The bill provides that the first $2,000 per year received by an individual for participation in a clinical trial shall not be counted as income for the purpose of calculating Social Security benefits.  This provision was included in the House-passed health care reform bill last November, but was not included in the final bill the President signed into law in March.

The Senate already passed this bill on August 5.  House passage later today will clear the bill for review and signature by the President.

The provisions taking effect today that impact the colorectal cancer community are:

Coverage of Preventive Services: New plans must provide dozens of preventive services – including colonoscopies – without charging a copayment (any preventive service with an A or B rating from the Unites States Preventive Services Task Force must be covered).
Why This Is Important: Eliminating cost sharing requirements for preventive colorectal cancer screening will lower the cost of screening services for individuals which will help to increase population-based screening rates thereby helping to lower the incidence and mortality rates from this disease that is preventable and treatable if caught early.
Loophole: The law waives the deductible when a screen turns diagnostic, but not the co-pay. The Colorectal Cancer Coalition believes a fix needs to be enacted so that the co-pay is waived for a screening colonoscopy when it turns therapeutic.

Elimination of Lifetime Limits: No lifetime limits on benefit payouts.
Why This Is Important: Many colorectal cancer patients face a lifetime of cancer treatment. Caps on insurance result in very difficult decisions about the care they will receive and how they are going to pay for it.
Loophole: Lifetime limits are still generally permitted to the extent that the benefits are not “essential health benefits.” Future regulations will define the term “essential health benefits.” For now, the term includes at least the following categories of service: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative services and devices; laboratory services; preventive and wellness services and chronic care management; and pediatric services.

Elimination of Annual Limits: Begins to phase out annual limits on benefit payouts, starting by making the limit no less than $750,000. While the lifetime prohibition is immediate, the prohibition against annual dollar limits is phased in through 2014 for “essential health benefits.”
Why This Is Important: See above – same reason that the elimination of lifetime limits is important.
Loophole: May be limited in some cases. Employers whose plans don’t meet requirement can apply each year for a waiver. Individual plans that are grandfathered are also exempt.

Prohibition Against Recissions: The Affordable Care Act prohibits health insurance plans from dropping you or reducing your benefits if you become sick. Applies to both grandfathered and non-grandfathered plans.
Why This Is Important: Newly diagnosed patients will no longer have to worry that they might lose their health insurance coverage because of their cancer diagnosis.

A lot of attention has focused on the elimination of pre-existing condition exclusions. Eliminating pre-existing conditions exclusions is very important for cancer patients. Pre-existing condition exclusions lock the millions of Americans with at least one chronic illness (nearly one third of the population) into existing plans and employment. While this provision takes effect for children today, it is phased in and it is not until 2014 that all group health plans will be prohibited from imposing any pre-existing condition exclusions on children and adults.

Read more about the provisions taking effect today in a special guest blog from Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight “Six Months of the Affordable Care Act: Rights and Protections for Cancer Patients.”

And to learn more about provisions that have already taken effect, and about the provisions that are still to come and will be phased in until the Affordable Care Act fully takes effect in 2018 take a look at our Health Reform and You Webpage.

And remember there is still work to be done! Even after all the provisions of the Affordable Care Act take effect in 2018, many Americans may be newly insured but will still fail to receive the right treatment at the right time. The Colorectal Cancer Coalition continues to support research to help develop new treatments and to support efforts to increase awareness about the importance of early detection and screening.

Jay Angoff (image courtesy of the U.S. Department of Health & Human Services)

If you or a loved one has lived with cancer – you probably know more about the American health insurance system than you ever wanted. While most Americans have health insurance, few really know much about how their insurance works until the worst possible moment, when they are sick and need potentially life-saving care.

During the health reform debate, President Obama talked about the devastation of watching his mother battle both ovarian cancer and her insurance company. Unfortunately, such stories are all too common.

Thanks to the Affordable Care Act, fewer cancer patients are going to have to fight that two-front war. And many of the new patient rights and protections that will help cancer patients are beginning to take effect NOW, starting September 23rd. For example:

• Ending limits on care and benefits. Insurance companies can’t impose lifetime limits. And in most health plans, annual limits will be restricted. This means that your health insurance will be there right with you, covering your treatments, as long as you need it.
• Ending rescissions. If you get sick, your insurance company can’t drop you from coverage just because you made a mistake on your paperwork. If you keep paying your premiums and act in good faith, you won’t face losing your health insurance the moment you need it most.
• Appealing denied claims. If you are in a new plan, and your insurance company denies a claim, you have new rights to a fast and fair appeals process so you can ask them to reconsider that denial. This holds insurance companies accountable for delivering the benefits patients are entitled to.
• Covering kids. Cancer can strike at any age. Now, plans that offer coverage to your kids will have to continue covering them up to age 26, as long as they can’t get coverage through their own job. And most insurance companies can’t deny coverage to kids under age 19 because of a pre-existing condition, so you know you can buy your kids coverage if your employer doesn’t cover them.
• Choosing your own doctors. Now, new health plans have to let patients choose their own doctor from the plan’s network. And if you are in an emergency medical situation, you can’t be charged more to get treatment at a hospital out of your network.
• Keeping you healthy. As the saying goes, an ounce of prevention is worth a pound of cure. Now, new plans have to provide a number of preventive services without cost sharing. These include numerous cancer screenings, so more cancer cases will be detected early, as well as counseling and screenings to help prevent chronic conditions that contribute to poor health like heart disease, diabetes, and obesity.

Fighting cancer is a fight for your life – Americans shouldn’t have to fight their insurance companies at the same time. Now, thanks to the Affordable Care Act, patients have new tools and resources to get the care they need and take back control from insurance companies.

The new guidelines will mean that insurance plan can no longer charge copayments or other fees for a number of preventive services including colorectal cancer screenings.  The regulation does not take effect until Sept. 23, and it only applies to plans that are new after that, meaning that people who stay on their existing plan won’t benefit from the change.

Colorectal Cancer Coalition President Carlea Bauman was invited to the event, which was attended by about 50 other health care leaders, doctors, and nurses.

During her remarks, Secretary Sebelius said that “[t]oo many Americans don’t get the preventive care they need to stay healthy.”  A conclusion the colorectal cancer community is well aware of with colorectal cancer continuing to be the third most commonly diagnosed cancer in men and women and the second most common cause of cancer death.

Interested in learning more about today’s guidelines and other provisions in the Affordable Care Act that will affect the colorectal cancer community?  Take a look at our webinar that provides an overview of the Affordable Care Act through a cancer lens.

If you were not able to join us for the live webinar, you can access a video of the webinar or download the slides from the presentation.

Still have questions about the Affordable Care Act, and how it changes access to colorectal cancer screening and impacts the cost of cancer care?  Email us at Advocacy@FightCRC.org.