U.S. health care reform and prostate cancer — today and tomorrow

Neither The “New” Prostate Cancer InfoLink nor the vast majority of Americans really look at the recent health care reform controversy as “all good” or “all bad.” (We apologize to non-U.S. readers for addressing this topic, but it is somewhat basic to the entire way our American readers get health care at all.)

We have no intention of debating the pros and cons of the actual Act and its supplementary modifications through “reconciliation,” which have already been signed into law by the president. What we do, however, feel we should comment on is the impact of this Act of Congress on prostate cancer today and tomorrow, because it does have some very profound effects.

So, in the “good for patients” column:

  • Effective this year, preventive care will be available to Medicare beneficiaries without co-payments or deductibles (although it is not entirely clear yet whether this will include the costs of PSA and DRE tests in all states).
  • Effective immediately, steps will be taken to fix the Medicare Part D coverage gap (the “doughnut hole”) — in 2010, those who hit the coverage gap will receive a $250 rebate; starting in 2011, the cost of drugs in the coverage gap will go down by 50 percent, and the doughnut hole will gradually be phased out completely over time.
  • Neither a diagnosis of prostate cancer nor a prior diagnosis of some other disorder will make it possible for a health insurance organization to deny coverage because of a pre-existing condition (this becomes effective immediately for children under the age of 19, but it will take until 2014 for this condition to be fully implemented).
  • Effective immediately, insurance plans will be barred from imposing lifetime caps on coverage, and restrictive annual limits will be also be capped; in addition, when insurance exchanges begin operation in 2014, no caps will be allowed at all.
  • Effective immediately, insurers will be prevented from canceling insurance policies retroactively, except for fraud.
  • Within 90 days, people with medical conditions that make them uninsurable may be able to get coverage through a federally subsidized health insurance program (although the legislation limits spending for this program to $5 billion).
  • The Act requires coverage for routine patient care costs for those with cancer and life-threatening illnesses who are enrolled in clinical trials (specifically for patients with private insurance plans and those covered through the Federal Employees Health Benefits program).
  • The Act establishes the Cures Acceleration Network initiative, which is intended to cut the time between discovery and development of drugs and therapies through new grant-making mechanisms that encourage private and non-profit partnerships.
  • Some 32 million Americans who previously had no health insurance will now be able to get such insurance; this will presumably mean that many men with prostate cancer will now be able to get better care for for their disorder.

Passage of this legislation has polarized America. Whether it is a “good thing” or a “bad thing” depends on all sorts of factors that influence the points of views of individuals. Some of those factors are “real;” others have been hyped into being and have no basis in fact. And that is true regardless of which political viewpoint you might have of the topic.

The “New” Prostate Cancer InfoLink would ask readers to realize that this is not all “done” — by any manner of means. Most specifically, we need to be hypervigilant in ensuring that the only tests we have today for the early detection of prostate cancer continue to be covered. The PSA test is far from being an ideal test for prostate cancer risk — but it is all we have today. It would be a travesty to lose coverage for PSA testing as a consequence of this Act. It is almost certainly the case that not every man over some specific age needs a PSA test every year — but a significantly elevated PSA level or an anomalous area on the prostate felt on a DRE are the best ways we have today of deciding whether a man needs a prostate biopsy.

Over the next decade, Americans will learn to operate within a new health care structure. Hopefully, we will also all learn how to operate within this structure with a recognition that there will still be cost consequences if we do not use this structure with intelligence.

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