This afternoon, Federal Judge Roger Vinson issued a ruling in a lawsuit brought by 26 states and the National Federation of Independent Business (NFIB) alleging that the Affordable Care Act is unconstitutional.

Judge Vinson agreed with the states’ argument that the new law violates people’s rights by forcing them to buy health insurance by 2014 or face penalties (this is the so-called “individual mandate” provision). His ruling strikes down the entire law finding that the individual mandate provision cannot be severed from the rest of the law.

Attorneys for the Administration had argued that the states did not have standing to challenge the law and that the case should be dismissed (several other lawsuits brought against the law have been dismissed for lack of standing before arguments could be hear on their merits).

“The existing problems in our national health care system are recognized by everyone in this case. There is widespread sentiment for positive improvements that will reduce costs, improve the quality of care, and expand availability in a way that the nation can afford. This is obviously a very difficult task. Regardless of how laudable its attempts may have been to accomplish these goals in passing the Act, Congress must operate within the bounds established by the Constitution. Again, this case is not about whether the Act is wise or unwise legislation. It is about the Constitutional role of the federal government…I must reluctantly conclude that Congress exceeded the bounds of its authority in passing the Act with the individual mandate….Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void.” Vinson wrote.

Read Judge Vinson’s decision.

Vinson’s ruling may be appealed to the U.S. Court of Appeals in Atlanta.

Two other federal judges have upheld the individual mandate, but a federal judge in Virginia also ruled the requirement unconstitutional. In May the federal appeals court in Richmond, Virginia is scheduled to hear challenges to two conflicting federal court ruling in that state.

Both the Florida and the Virginia cases are expected to proceed toward the U.S. Supreme Court.

For an overview of how the Affordable Care Act affects the colorectal cancer community, check out our webpage http://link.fightcrc.org/healthreformandyou.

Today, Gene Dodaro, Comptroller General of the United States and head of the U.S. Government Accountability Office (GAO), announced the appointment of the following 15 individuals to the Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI).

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.

The House is set to vote this afternoon on the Improving Access to Clinical Trials Act of 2010 (S. 1674) introduced by Senator Ron Wyden (D-OR).

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.

Health reform is back in the news this week.  Why?  Today marks the six-month anniversary of the President signing this landmark legislation into law and several of the most-talked about and popular provisions of the law take effect today.

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.

By Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight

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.

We took a look at the Affordable Care Act through a cancer lens in order to better understand how the law will affect the colorectal cancer community.  Whether you favored or opposed enactment of the Affordable Care Act, a full understanding of the new law is essential as it will change many areas of health care.  We put together a webinar that will give you an overview of what is happening when and how it will impact you.  It gives an overview of upcoming implementation deadlines as well as opportunities for patients and advocates to get involved in the implementation process.

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.