On Thursday afternoon, Senate Majority Leader Reid (NV) set the procedural wheels in motion for a vote on the Patient Protection and Affordable Care Act.

The first procedural vote is expected around 8pm on Saturday.  It will be a cloture vote on the motion to proceed.  Majority Leader Reid is working to line up the 60 votes needed to pass the cloture motion (a cloture motion must be approved by three-fifths of the Senate).

Continue reading for more information on the upcoming Senate vote as well as a summary of some of the provisions included in the Senate bill that C3 thinks are important for people living with colorectal cancer.

Typically, a cloture vote will be followed by a second procedural vote – a vote on the motion to proceed.  This vote requires a simple majority vote to pass.  However, Senate Republicans have agreed to waive this second procedural vote and forego reading the bill on the Senate floor in exchange for an all-day debate on the bill on Saturday (without this agreement, the Senate rules would have only required one hour of debate before the cloture vote).

The New York Times reports that Democratic Sens. Ben Nelson (NE), Mary Landrieu (LA), and Blanche Lincoln (AR) “are proving tough sells” on health care reform, “raising the prospect that one or perhaps all three of them could scuttle the bill before the fight over it even begins on the Senate floor.”  Should the cloture vote fail, Democrats may be forced “to regroup and redraw the measure or even switch to a more contentious procedural shortcut around the need for a 60-vote majority.”  Politico has a good article on the fast track options for moving the legislation forward.

Be sure to tune in and watch the debate and vote on Saturday.  You can watch the vote on C-Span’s website.

The $849 billion Patient Protection and Affordable Care Act includes a public option that will extend health insurance coverage to 31 million Americans.  The reimbursement rates for the public plan will not be tied to Medicare, and co-ops will still be offered.  The bill will create an insurance exchange where people can compare and purchase health insurance, it expands Medicaid coverage to those earning 133 percent of the federal poverty level, and it offers subsidies to help those without employer sponsored insurance purchase health insurance.

Increasing the number of Americans with health insurance will help reduce mortality rates from colorectal cancer.  Many studies show that people who are uninsured are substantially less likely to be screened for colorectal cancer.  In addition, insurance status strongly influences survival among those diagnosed with colorectal cancer – individuals with private insurance who are diagnosed with Stage II colorectal cancer have better survival outcomes than individuals who are uninsured and are diagnosed with Stage I colorectal cancer.

Like the House health reform bill, the Senate bill eliminates 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.

The bill will eliminate cost-sharing requirements for all preventive services (including colorectal cancer screening) that have a United States Preventive Services Task Force (USPSTF) A/B rating, and require coverage of these tests by private insurance.

It also has a section regarding community preventive screenings, and specifically lists cancer screenings as one of the community interventions needed to improve public health.

The bill establishes a prevention and public health fund to be administered through the Office of the Secretary at the Department of Health and Human Services to provide for an expanded and sustained national investment in prevention and public health programs.  This new fund will support public health activities including prevention research and health screenings.

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.  The Patient Protection and Affordable Care Act eliminates “unreasonable annual benefits” and lifetime limits on the dollar value of benefits for any participant or beneficiary for all group health plans and health insurance coverage required to provide “essential health benefits” (i.e., any insurance company or plan that participates in the new health insurance exchange).

Senate Democrats have complied a section-by-section summary of the bill along with a timeline for implementation of the various provisions in the bill.  In addition, the Congressional Budget Office (CBO) has reviewed the legislation.  CBO’s analysis and cost estimate of the bill is available online.

The cloture vote on Saturday is an important step in getting a final health reform bill sent to the President, but there is still a long road ahead for health reform and many areas where the pending bills could be improved.

C3 has been closely following the various health reform proposals introduced in Congress, and will continue to work with legislators to advocate for 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.

Catherine Knowles is C3′s new Director of Policy

The health care reform debate continues.  Last week, the Senate Finance Committee discussed Senator Baucus’s proposal and considered hundreds of amendments.  The Committee will hold a final vote on the proposed bill later this week.  This will allow the Congressional Budget Office (CBO) time to complete its analysis of the bill and provide a final cost estimate.  After the Finance Committee has approved the bill, it will be combined with the bill from the Senate Health, Education, Labor and Pensions Committee before it is scheduled for a vote on the floor by the full Senate.

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

Continue reading for more information on some of the amendments adopted by the Senate Finance Committee that C3 thinks are important for people living with colorectal cancer.

C3 was pleased to see that the Senate Finance Committee made significant changes to the health reform overhaul package it considered that will make health care more affordable and accessible.

Sen. Cantwell (D-WA) sponsored an amendment that will let states create low-cost health insurance plans for low-income families.  The amendment is designed to encourage states to enact a program mirroring the Washington State Basic Health plan.  It will allow states to put people making more than 133 percent of the federal poverty level (the upper threshold for Medicaid in the mark) and less than 200 percent of the federal poverty level (approximately $44,000 for a family of four) in a state-based government plan.  The amendment provides a federally funded, non-Medicaid, state plan which combines the innovation and quality of private sector competition with the purchasing power of the states.  It passed 12-11.  This amendment would help expand coverage to people who currently cannot afford insurance.  And without insurance, people are less likely to be screened, let alone able to be treated for colorectal cancer.

The committee also adopted along party lines an amendment sponsored by Senate Finance Health Subcommittee Chairman Rockefeller (D-WV) regarding so-called “Cadillac” insurance policies – expensive policies with low deductibles, limited co-pays and extensive benefits.  Senator Baucus proposed taxing the insurers for plans that cost over $8,000 anually ($21,000 for a family) in order to help offset costs of coverage for the uninsured.  In addition, there is an underlying assumption that “Cadillac” policies encourage inappropriate over-use of medical care – and taxing these policies could help make them less attractive.   However, some of the committee were concerned that some consumers – people in high-risk jobs, or older Americans – have to spend that much for “Chevrolet” coverage.  They felt that the costs should be increased.  Under the Rockefeller amendment, the cost of the plans for retirees older than 55 and those in high-risk professions must total $9,850 for individuals and $26,000 for families before they are considered “Cadillac” and therefore taxable.  The threshold tops the amounts in the underlying proposed bill by $1,100 for individuals and $3,000 for families.

Colorectal cancer patients tend to be older – most people are diagnosed over age 50.  And the cost of insurance policies increases significantly as people age.  The Rockefeller amendment will increase affordability to policies for retirees over age 55.

The Rockefeller amendment also guarantees that the independent commission set up to find savings in Medicare cannot propose increases to Medicare premiums.  This will reassure Medicare recipients who are concerned about cuts in benefits accompanied by increases in premiums.

The Committee also addressed comparative effectiveness research.  Comparative effectiveness research (CER) compares treatments – for example, does ibuprofen, aspirin or acetaminophen work better for a headache?  Senator Baucus proposed the formation of a Patient-Centered Outcomes Research Institute (PCORI) which would be responsible for coordinating CER data and communicating results with health care providers and the public.  Comparative effectiveness will help determine what therapies can be used to effectively treat those with colorectal cancer.  Any provisions related to comparative effectiveness research should be conducted through an open and transparent process involving all stakeholders, starting from the research planning stage.  During the Senate Finance Committee markup, Sen. Grassley (R-IA) sponsored an amendment designed to improve the PCORI governance of patient-centered outcomes research institute.  The amendment would not allow the Secretary of Department of Health and Human Services, the National Institutes of Health, and other high-ranking officials, including elected officials and appointees, from being board members of the institute.   It was agreed to by voice vote.  Ensuring that patient voices are represented and that politics is kept out of comparative effectiveness research is extremely important to ensuring that patients continue to have access to innovative and life-saving medical treatments.

You can read the entire text of the Senate Finance Committee bill as amended online.

Risk of dying during that first year was 50 to 90 percent higher among the uninsured.  They were more likely to diagnosed at an advanced stage and live in poor neighborhoods.

Other illness (comorbidities) was lowest in privately insured patients and highest in patients under 65 on Medicare, who were likely to have Medicare because of a disability.

Trying to track down reasons for why uninsured colorectal cancer patients have poorer survival, researchers at the American Cancer Society in Atlanta analyzed information for nearly 65,000 patients with colorectal cancer in the National Cancer Data Base in years 2003 through 2005.  In addition to cancer information, they studied comorbidities to see if they were contributing to increased deaths.

After adjusting statistics for factors known to affect survival including age, stage at diagnosis, where patients were treated, and neighborhood education level and income, risk of dying was significantly higher for all patients without private insurance—78% higher for uninsured patients, 64% higher for those insured by Medicaid, and 86% higher for those insured by Medicare.

However, although patients who were uninsured or who had Medicaid or Medicare had more comorbidities than patients with private insurance, that difference didn’t have an impact once insurance status was figured in.

Anthony S. Robbins, MD, PhD and his colleagues in the Department of Surveillance and Health Policy Research at theAmerican Cancer Society in  Atlanta concluded,

Thus, using data from more than 64,000 colorectal cancer patients in a large national database, we found substantial differences in comorbidity level by insurance status, but these differences did not explain the poorer survival of patients without private insurance. Even after adjustment for age, stage, facility type, neighborhood education level and income, and number of comorbid conditions, whites and blacks without private insurance had 40% to 80% higher risk of death during the first year after diagnosis. These higher death rates translated into large reductions in 1-year survival for patients without private insurance and those with higher comorbidity levels.

SOURCE: Robbins et al.,Journal of Clinical Oncology,Volume 27, Number 22, August 1, 2009.

Having an on-going relationship with a doctor (medical home) made a difference.  People who had been seeing their primary care doctor for more than five years were two and a half times more likely to have been screened.

The North Carolina Division of Medical Assistance, the state agency responsible for Medicaid in North Carolina, reviewed the records of patients over 50 kept by their primary care doctors.  They found that many patients were not being offered screening for colorectal, breast, and cervical cancer and fewer were actually getting the tests.

• For colorectal cancer, 52.7 percent of patients were offered screening, 28.2 were tested.
• 60.4 percent of women were sent for mammograms, 31 percent got the exams.
• Pap smears were recommended to 51.5 of eligible women, but 31.6 percent actually were tested.

Like colorectal cancer screening, women with a stable, long-term relationship with their doctor were more than twice as likely to have receive mammograms.  The study authors wrote,

This finding underscores the value of a stable medical home in achieving national objectives for receipt of preventive services.

The researchers also pointed out that all patients in the study had access to primary health care and payment for screening, including colonoscopy.  Almost all of the patients (80 percent) who got colorectal screening got it via colonoscopy.

C. Annette DuBard M.D. M.P.H. and her colleagues concluded,

Cancer screening rates among older Medicaid recipients fall far short of national objectives. Lack of a screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency. Efforts to increase cancer screening rates among Medicaid recipients must address patient, physician, and organizational barriers to the routine identification and delivery of preventive services.

SOURCE: DuBard et al. Archives of Internal Medicine, Volume 168, Number 18, October 13, 2008.