NCCN News
Journal: Journal of the National Comprehensive Cancer Network (2019)

The State of Cancer Care in America: The Impact of State Policy on Access to High Quality Cancer Care explored the role of federal waivers, shifting regulatory authority, trends in cancer care policy at the state level, and other ways that state policy is having a growing impact on access to highquality cancer care.The summit included a keynote from the Deputy Majority Leader of the Connecticut State Senate, Matthew Lesser, a cancer survivor, who described his work on state-level health reform legislation."Ongoing changes to the balance between federal and state power over healthcare policy can have a significant impact on the way people in America access healthcare, now and in the future," said Robert W. Carlson, MD, Chief Executive Officer, NCCN."States have more flexibility than ever before in how they structure their insurance markets, but implementation is highly variable and it's not clear how patients with cancer fare in some of these novel approaches.We convened this summit to explore some of the innovative concepts for improving healthcare delivery, and also to highlight areas of difficulty that could contribute to growing inequities."The first panel focused on an overview discussion of the various tools the federal government is allowing states to experiment with, including waivers, CMS guidance, work requirements, premium contributions, and block grants.Speakers also described specific initiatives that are taking place within various states."The Healthy Indiana Plan (HIP) is a consumer-driven alternative to traditional Medicaid that has provided coverage to over 400,000 Hoosiers, including many patients with cancer who might not otherwise have access to health insurance," said John R. Edwards, MD, Indiana Blood and Marrow Transplantation."Many patients with cancer are exempt from certain innovative aspects, such as the Gateway to Work program which provides and requires job training or other education, community engagement or work opportunities to able-bodied participants.Yet changes in coverage, reassignment, and delays in authorizations and approvals remain logistically challenging and are particularly impactful to our at-risk patients with cancer.Improving systemwide efficiency for HIP patients and healthcare providers remains a daunting challenge for complex, costly patient care."The second panel drilled down further into what is working well for individual states and where potential problem areas may arise.Speakers were particularly concerned with how an individual's ZIP code can impact the health services they have access to, and whether the so-called "birth lottery" can result in widening disparities between states."Massachusetts has been at the forefront for ensuring broad coverage for its residents.In 2006, Massachusetts passed a law that served as the foundation for the Affordable Care Act (ACA) that passed 4 years later.97% of state residents now have health coverage," said Anne Levine, MEd, MBA, Dana-Farber Cancer Institute."After achieving near universal coverage, in 2012 the state passed another sweeping bill that focused on affordability.The Massachusetts legislature has long-supported public health and cancer control priorities and has passed bills on oral chemotherapy parity, tobacco 21, and restrictions on tanning salons.During the current legislative session, the state is considering bills to require access to fertility treatments for women with cancer, ban the sale of flavored tobacco products including e-cigarettes, reform the insurer practice Cont.