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.

Register for C3′s upcoming webinar to learn more about the new health care reform law including: upcoming implementation deadlines; opportunities for advocates to get involved; and an explanation of how the law will affect the colorectal cancer community.

The new HHS web portal, HealthCare.Gov, includes a yellow-page like listing of health insurance plans.  By October, HHS would like to have more information available on the site for consumers – information about plan costs and coverage benefits as well as data about insurance claims (for example, the percent of claims denied and the percent of claim denials that have been appealed).

The New Pre-Existing Condition Insurance Plan (PCIP) is a stopgap fix for the most vulnerable until 2014, when core provisions of the new health care law take effect.  In order to enroll in the PCIP program an individual must meet the following eligibility requirements:

• Be a U.S. citizen or legal resident.
• Have a pre-existing medical condition.
• Been uninsured for six months or longer.

If the PCIP program in your state is run by HHS, you can apply to participate in the program online.  While individuals can apply for the HHS run Pre-Existing Condition Insurance Plan today, the premium rates won’t be officially available until July 15.

Premiums will vary from state to state.  If you live in a state where HHS provides coverage, the premium for an age 50 year old enrollee may range between $320 and $570.  In California, for example, the cost for a 50-year-old is estimated at $575 a month, with a $1,500 annual deductible and 15 percent co-insurance.  Premiums in states with lower medical costs could be around $400 a month.

If your state is one of the 30 states running its own Pre-Existing Condition Insurance Plan you can get information about eligibility requirements, premiums, and how to apply online.

Millions of Americans are have been denied insurance coverage because of a pre-existing medical condition, and experts estimate that the new PCIP program could enroll as many as 375,000 people this year, but run out of money around the end of 2011.  While Congress has already appropriated $5 billion to fund the PCIP program through 2013, the Congressional Budget Office estimates that another $5 billion to $10 billion will be needed to fully meet the enrollment demand and prevent the program from running out of money before the core provisions of the new health care law take effect in 2014.  It’s unclear what the Administration and Congress will do if the money runs out.

To make matters more confusing, most states already operate their own high risk insurance pools, covering about 200,000 people in total.  However, the state plans tend to charge significantly higher premiums than the new PCIP program, and many offer fewer benefits.  Individuals currently enrolled in a state high risk pool will not be able to switch from state to federal coverage (to switch to receive coverage through the PCIP program an individual would have to risk going six months without health insurance).

Register for C3′s upcoming webinar to learn more about the new health care reform law including: upcoming implementation deadlines; opportunities for advocates to get involved; and an explanation of how the law will affect the colorectal cancer community.

Some headlines from this issue:

• Palliative Care: Not Just for End of Life
• Listening to the Little Voice
• Patient to Patient Advice for Caregivers
• Health Care Reform & Cancer: Your Implementation Guide

You’ll also read testimonials from advocates who attended the C3 Call-on Congress in March and learn about the young, innovative researcher who is looking into new treatments for late stage colorectal cancer, thanks to a grant from C3.

To receive Momentum free at home, sign up at the C3 Action Center.

In a letter to governors, Secretary Sebelius laid out several options states will have to use $5 billion in the Patient Protection and Affordable Care Act to bridge the time from July 1, 2010 until January 1, 2014 when the insurance exchanges will be available.

Coverage will need to include at least a floor set of benefits established by the federal government.  Out-of-pocket costs are limited to $5,950 for an individual, and premiums cannot be set at more than the existing standard non-group rates.  There can be no exclusion for pre-existing conditions.

Governors were asked to respond with a letter of intent by April 30, 2010.  If a state does not want to participate in the program, the Department of Health and Human Services will provide the high risk pool services to needy individuals in that state.

In order to be eligible coverage through the high risk pools, individuals must,

• Be a citizen or national of the United States or lawfully present in the United States.
• Not have had credible coverage for the six months before applying for coverage.
• Have a pre-existing condition.  The Secretary will provide guidance as to what determines pre-existing conditions.

States will have the option to,

• Operate a new high risk pool alongside a current state high risk pool.
• In states without high risk pools, establish a new one.
• Build upon other existing programs designed to cover people with pre-existing conditions.
• Contract with a current HIPAA carrier of last resort or other carrier, to provide subsidized coverage for the eligible population, or
• Do nothing, in which case HHS would carry out a coverage program in the state.

Writing to governors, Secretary Sebelius stressed willingness to be flexible in getting the program off the ground.

In reviewing the existing state high risk pools, there is much common ground in the benefits currently provided. Since HHS is considering establishing a floor set of benefits that all the new high risk pool programs must cover, we anticipate that these benefit requirements would take into account benefit lists currently used by existing state high risk pools. Similarly, states would have the option to follow pre-existing condition criteria for determining eligibility established by the Secretary, or propose their own, subject to Secretarial approval. We are committed to working with states to identify other areas where flexibility is appropriate.

Although many of the provisions of the new law are phased in to take effect gradually until the entire law is implemented in 2018, some benefits will be available immediately.

Highlights of the provisions that will benefit individuals people facing cancer treatment include: prohibiting insurance companies from dropping patients who become sick; eliminating lifetime and annual limits on coverage; prohibiting insurance companies from denying coverage because of pre-existing conditions; and limits on on out-of-pocket expenses.

You can review a chart developed by C3 with key issues affecting colorectal cancer prevention and treatment that are part of the health care reform legislation.

While historic, enactment of this new law is just one step in an ongoing process.  Even after all the provisions in the new law 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.

BENEFITS IF YOU HAVE BEEN DIAGNOSED WITH COLORECTAL CANCER:

• Beginning immediately, health insurance plans cannot drop you or reduce your benefits just because you become sick, a process called rescission.
• After January 1, 2014, insurance plans will not be able to deny coverage or charge higher premiums if you have a pre-existing condition.  Until that time, people with pre-existing conditions will be able to find affordable insurance in special high-risk pools supported with federal funds.  For people with inherited colorectal cancer who worry about testing for a genetic condition, the law specifically includes genetic information among the health conditions for which there cannot be discrimination.
• Six months after the the law is enacted, insurance companies can no longer place lifetime limits on healthcare coverage, nor can they impose restrictive annual limits.  In 2014, all group and individual plans must eliminate annual limits.  Even if you need expensive cancer care, you will no longer need to worry about your insurance refusing to meet those costs.
• Depending on your income, there will be limits on the amount of money you need to pay out-of-pocket for health care for you and for your family each year.
• In 2014, uninsured people will have access to several new options including higher income limits for Medicaid and participation in an American Health Benefit Exchange.  The exchanges will clearly outline costs and benefits of each health care policy so consumers can make  informed choices about care.  Subsidies will be available to keep costs affordable.

BENEFITS IF YOU WANT TO PREVENT COLORECTAL CANCER:

• If you are privately insured through your employer or the insurance exchanges, preventive services are covered fully without your having to meet a deductible or pay a co-pay.
• If you are on Medicare, cost-sharing for preventive screenings will end on January 1, 2011.  In addition, there will be no additional co-payments if a polyp is discovered and has to be removed during the screening exam.  Medicare will also pay for an annual check-up.
• If you are on Medicaid preventive services will be provided at no cost.

OTHER IMPACTS ON COLORECTAL CANCER PREVENTION:

While not specifically addressing colorectal cancer, wellness and prevention of illness are addressed in several new initiatives established and funded by the law including:

• Establishment of a National Prevention, Health Promotion and Public Health Council to coordinate prevention, wellness, and public health strategies.
• Establishment of a Prevention and Public Health Fund to expand and sustain funding for prevention and public health programs, as well as task forces on Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services.
• Grants to support evidence-based community prevention and wellness programs that strengthen prevention activities, reduce chronic disease rates and address health disparities, especially in rural and frontier areas.  Funding for five years beginning in FY 2010.

If you have questions about how the new law will affect you, the New York Times has an interactive site where you can look at your personal impact whether you are insured or uninsured and whether your current insurance is on your own, through an employer, or via Medicare or Medicaid.

So, what exactly will the pending legislation do?

Take a look at a side-by-side chart comparing some of the provisions in the House-passed, Senate-passed, and pending House reconciliation bills that C3 thinks are important for people living with colorectal cancer.  The chart also includes links to the full text of each of the bills, so that you can read the complete legislation.

The reconciliation bill will contain changes to the Senate bill needed to get the support of House Democrats.  Passing an amended bill under reconciliation rules will allow the Senate to consider and pass the changes under special rules requiring a simple majority to pass rather than a 60-vote majority.  Congressional leaders hope to send a final bill to President Obama no later than the Easter Congressional recess.

The two key differences between the House and Senate bills are the public option and pay-fors.  The House bill would create a government-sponsored insurance plan (i.e., a public option), but the Senate bill is silent on this point.  How to finance the health care expansion is also a contentious issue.  House members refused to consider the so-called Cadillac tax (i.e., a tax on expensive insurance plans) but the Senate has taken the opposite approach to financing and included a wealth surtax (the so-called millionaires’ tax) rather than including a Cadillac tax.  The House bill also has stricter language against funding for abortion.

The Senate passed their bill on Christmas Eve by a vote of 69-39.  And the House passed their bill on Nov. 7, 2009 by a vote of 220-215.

C3 has been closely following the various health reform proposals introduced in Congress because access to care is critical to preventing, treating and beating colorectal cancer.  Read more about the provisions in the House-passed and Senate-passed bills that will affect colorectal cancer patients.

View a side-by-side comparison of the House-passed and Senate-passed bills here.  View the President’s health reform proposal here.

The President will offer brief opening comments, followed by Republican and Democratic Members of Congress chosen by their colleagues.  They will then begin discussions around following four themes:

1. Controlling costs;
2. Insurance reforms;
3. Reducing the deficit; and
4. Expanding coverage.

The President will be seated in the middle of one side of the hollow square, with the Vice President, Secretary Sebelius, and congressional Leadership seated alongside him at the table.  Members of Congress will be seated by caucus around the square.

Members of Congress expected to attend the meeting include:

• Senator Harry Reid, D-NV, Majority Leader
• Senator Mitch McConnell, R-KY, Republican Leader
• Senator Dick Durbin, D-IL, Majority Whip
• Senator Jon Kyl, R-AZ, Republican Whip
• Senator Max Baucus, D-MT, Chairman of the Finance Committee
• Senator Chuck Grassley, R-IA, Ranking Member of the Finance Committee
• Senator Tom Harkin, D-IA, Chairman of the Health, Education, Labor and Pensions Committee
• Senator Mike Enzi, R-WY, Ranking Member of the Health, Education, Labor and Pensions Committee
• Senator Chris Dodd, D-CT, Member of the Health, Education, Labor and Pensions Committee
• Senator Chuck Schumer, D-NY
• Senator Patty Murray, D-WA
• Senator Kent Conrad, D-ND
• Senator Jay Rockefeller, D-WV
• Senator Ron Wyden, D-OR
• Senator Lamar Alexander, R-TN
• Senator John Barrasso, R-WY
• Senator Tom Coburn, R-OK
• Senator John McCain, R-AZ
• Speaker Nancy Pelosi, D-CA
• Representative Steny Hoyer, D-MD, Majority Leader
• Representative John Boehner, R-OH, Republican Leader
• Representative James Clyburn, D-SC, Majority Whip
• Representative Eric Cantor, R-VA, Republican Whip
• Representative Charles Rangel, D-NY, Chairman of the Ways and Committee
• Representative Dave Camp, R-MI, Ranking Member of the Ways and Means Committee
• Representative Henry Waxman, D-CA, Chairman of the Energy and Commerce Committee
• Representative Joe Barton, R-TX, Ranking Member of the Energy and Commerce Committee
• Representative George Miller, D-CA, Chairman of the Education and Labor Committee
• Representative John Kline, R-MN, Ranking Member of the Education and Labor Committee
• Representative John Dingell, D-MI, Chair Emeritus of the Energy and Commerce Committee
• Representative Xavier Becerra, D-CA
• Representative Louise Slaughter, D-NY
• Representative Robert Andrews, D-NJ
• Representative Jim Cooper, D-TN
• Representative Paul Ryan, R-WI
• Representative Marsha Blackburn, R-TN
• Representative Charles Boustany, R-LA
• Representative Peter Roskam, R-IL

** Note: Senator McConnell and Leader Boehner will designate one additional Republican member to attend.**

C3 President Carlea Bauman at the National Press Club

Today, C3 hosted a forum with Olympus in Washington DC to discuss current trends in colorectal cancer screening and prevention.

C3 President, Carlea Bauman, gave keynote remarks at the forum.  Carlea spoke about the frustration that we face at C3 when we receive calls to our Answer Line from individuals looking for assistance finding affordable screening services and we only have a patch-work network of assistance available to them.  Carlea explained that the way to change this is with enactment of a national screening and treatment program, “I look forward to the day where a national program exists so that when these calls come in, we can say, ‘Yes, you can get screened and yes, you can afford it.’”

I spoke on one of the panels about the impact the pending health care reform legislation will have on colorectal screening and why even if health care reform passes we will still need to enact legislation creating a national screening and treatment program for colorectal cancer.  To read the text of my remarks, click here.

Other speakers at today’s forum included:

• Dr. David Johnson, MD, Professor of Medicine and Chief of Gastroenterology, Eastern Virginia Medical School
• Dr. Douglas Rex, MD, Director of Endoscopy at Indiana University Hospital and Professor of Medicine at Indiana University School of Medicine
• Mr. David Woodmansee, Senior Specialist for State and Local Campaigns, Colorectal Cancer Screening Programs, American Cancer Society Cancer Action Network
• Dr. Gregory Ginsberg, MD, Professor of Medicine and Director of Endoscopy, University of Pennsylvania Health System
• Dr. Laura Seeff, MD, Associate Director of Colorectal Cancer Programs, Centers for Disease Control and Prevention
• Dr. Ronald Myers, PhD, Director of the Kimmel Cancer Center and Professor of Medicine, Thomas Jefferson University
• Dr. Patrick Okolo, MD, Chief of Endoscopy, Johns Hopkins Hospital

The panelists provided an overview of where the nation is regarding colorectal cancer screening.  They discussed the role of insurance in screening rates and the difference between states with and without mandates.  They provided an overview of current guidelines and the strong evidence for screening as well as discussing the importance of quality in screening services.

Dr. Seeff with the CDC gave an overview of the CDC’s Screen for Life and Colorectal Cancer Control Programs.  She and the other panelists also discussed the lack of screening access for underserved populations and potential solutions.

Speakers also discussed the current and projected colorectal cancer screening capacity.  In addition, panelists discussed how adherence to guidelines and improving patient follow through are critical for doctors.

As soon as it is available, we will be posting video of today’s forum so that you can listen to the discussion from all of the panelists about the current state of colorectal cancer screening and prevention.

House and Senate Leadership were back at the White House today for another day-long negotiation session aimed at reconciling differences between the House-passed and Senate-passed bills.  President Obama is scheduled to met with Democrats this evening at the Democrats’ annual issues conference to talk about health care reform.

Congressional leaders are working to get a final compromise agreed to, and sent to the Congressional Budget Office (CBO) by Friday.  CBO will need 10-15 days to analyze the bill and put together a cost estimate.  Members want to see a final cost estimate and analysis before voting on the package.

The letter C3 sent asks Congress to:

• Eliminate pre-existing condition exclusions and waiting periods for all individuals in every health insurance market in order to ensure access to care.
• Completely eliminate annual and lifetime caps on coverage.

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.

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.

There are a number of additional provisions in both the House-passed and Senate-passed health care reform bills that will affect colorectal cancer patients.  Click here to see a chart outlining and comparing these provisions.

C3 will continue to work with legislators to advocate for improvements to the pending bills that will provide all Americans with the access to care that is critical to preventing, treating and beating colorectal cancer.

Please feel free to share your thoughts with us by leaving comments below.