New health care plans limit access to top cancer centers

MD Anderson Cancer Center included in less than half of plans in Houston area; Memorial Sloan-Kettering included by two out of nine plans in New York
Associated Press
Mar 19, 2014

Some of America's best cancer hospitals are off-limits to many of the people now signing up for coverage under the nation's new health care program.

Doctors and administrators say they're concerned. So are some state insurance regulators.

An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington's insurance exchange. MD Anderson Cancer Center says it's in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.

In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP's survey said patients have access through all the insurance companies in their states' exchanges.

Not too long ago insurance companies would have been vying to offer access to renowned cancer centers, said Dan Mendelson, CEO of the market research firm Avalere Health. Now the focus is on costs.

"This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans," Mendelson said.

Those patients may not be able get the most advanced treatment, including clinical trials of new medications.

And there's another problem: it's not easy for consumers shopping online in the new insurance markets to tell if top-level institutions are included in a plan. That takes additional digging by the people applying.

"The challenges of this are going to become evident ... as cancer cases start to arrive," said Norman Hubbard, executive vice president of Seattle Cancer Care Alliance.

Before President Barack Obama's health care law, a cancer diagnosis could make you uninsurable. Now, insurers can't turn away people with health problems or charge them more. Lifetime dollar limits on policies, once a financial trap-door for cancer patients, are also banned.

The new obstacles are more subtle.

To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans.

By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere.

For now, the issue seems to be limited to the new insurance exchanges. But it could become a concern for Americans with job-based coverage, too, if employers turn to narrow networks.

The AP surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network. Two additional institutions that joined this week were not included in the survey.

Cancer network members are leading hospitals that combine the latest clinical research and knowledge with a multidisciplinary approach to patient care. They say that patients in their care have better-than-average survival rates. The unique role of cancer centers is recognized under Medicare. Several are exempt from its hospital payment system, instituted to control costs.

AP asked the centers how many insurance companies in their state's exchange included them as a network provider.

Of the 19 that responded, four reported access through all insurers: the Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, Fox Chase Cancer Center in Philadelphia, Duke Cancer Institute in Durham, N.C., and Vanderbilt-Ingram Cancer Center in Nashville. One caveat: Some insurers did not include these cancer centers on certain low-cost plans.

Two centers had special circumstances. The best known is St. Jude's Children's Research Hospital in Memphis. Treatment there is free as long as children have a referral.

For the remaining 13, the gaps were evident.

In Buffalo, N.Y., Roswell Park Cancer Institute is included by five of seven insurers in its region. But statewide, the picture is much different: Roswell Park is not included by 11 of 16 insurers. Dr. Willie Underwood, associate professor of surgical oncology at the teaching hospital, says that's a problem.

"Overall, when you look at the Affordable Care Act, it improves access to cancer care," said Underwood. "When it comes down to the exchanges, there are some concerns that we have. That is not being critical, that is being intelligent. There are some things we should talk about ... before they start becoming a problem."

Melanie Lapidus, vice president for managed care at Barnes-Jewish Hospital in St. Louis, home to Siteman Cancer Center, said she doesn't think patients realize the exchanges offer a more restrictive kind of private insurance.

Lapidus cited Anthem Blue Cross and Blue Shield, which includes Siteman in many of its plans outside the Missouri exchange, but none within the exchange.

"We have had many people say to us, 'I picked Anthem because you guys are always in their products, and I assumed you would be in their exchange products'," Lapidus said. "It's still hard to tell who is in network and who is not."

In a statement, Anthem said its network was based on research involving thousands of consumers and businesses. "What we learned was that people are willing to make trade-offs in order to have access to affordable health care," the company said. "Our provider networks reflect this."

Huntsman Cancer Institute in Salt Lake City is included by five of six Utah insurers, but Mark Zenger, who manages the center's negotiations with insurance companies, said he's concerned about getting left out by Humana, a major carrier.

"We are worried about the potential to have these Humana exchange members seek treatment and have no other option," said Zenger.

Humana spokesman Tom Noland said patients can have access to Huntsman for complex procedures, on a case-by-case basis.

Some state insurance regulators see a problem.

"I want insurers to be able to innovate and come up with new product designs," said Mike Kreidler, insurance commissioner for Washington state. "At the same time, there is a requirement for regulators like myself to be vigilant to make sure there aren't unreasonable compromises."

The Obama administration says it has notified insurers that their networks will get closer scrutiny for next year in the 36 states served by the federal exchange. Cancer care will be a priority, it says.

 

Comments

deertracker

Who decides acceptable medical treatment right now? There is no single payer pooh.

Everyone dies pooh. When it's time it's time. There are no death panels. Stop with the lies. Saying it a billion times won't make it true Palin!

abigbear

oh and there is DEATH PANELS...Search Results

Mark Halperin's Sudden Claim That Obamacare Death Panels Exist ...
www.forbes.com/.../mark-halperin......‎
Forbes

Nov 26, 2013 - “The Affordable Care Act contains provisions for “death panels,” which decide which critically ill patients receive care and which don't. It's built ...
The Death Panels Are Coming - The American Prospect
prospect.org/article/death-panels-are-coming‎
The American Prospect
Dec 2, 2013 - ... can focus on in their endless war against the
Affordable Care Act. So get ready for the return of "death panels."

They never really went away.
Articles: Liberal Semantics and the Redefining of Death Panels
www.americanthinker.com/.../libe......‎
American Thinker
Nov 30, 2013 - Liberal Semantics and the Redefining of Death Panels. By Jeannie ... stated that cost-control rationing, aka death panels, are built into the ACA.

ObamaCare's cost-cutting board — memorably called a “death panel” by Sarah Palin — is facing growing opposition from Democrats who say it will ... on a proposal to encourage end-of-life planning in the Affordable Care Act.

Contango

Re: "There are no death panels."

So why has big lefty Paul Krugman used the term?

As ignorant as ever, 'turd.

Enjoy your Medicaid.

The Hero Zone's picture
The Hero Zone

Meanwhile Kevin Trudeau was sent to jail for ten years over his health scam. Huh...

meowmix

It is sad that this story only validates teatards fear and contempt for the current administration. An individual may end up paying more for health coverage and will not be insured by their current health policy, but then they really shouldn't want to; many low cost and cheap health plans offer at best what amounts to no coverage at all! The ACA and health care in this country are by no means ideal or without flaw, but in the long term, offer considerably better coverage and better health care. People might want to look a year or two in the future and see what it will do or not do, and they will likely see a net positive effect for a majority of those affected. You aren't going to obey the law Sam? Fine by me! Just don't count on the hospital writing off your tab in the event of a catastrophic illness/injury and passing it on to the taxpayer--it's your responsibility to have adequate health insurance and pay your own medical bills. JibberJabber is exactly right also about this center also--let them close down then!

rbenn

WOW really? Close down the best hospitals in the world? That's the most ignorant statement ever made. I will tell you as a parent of a child that battled brain cancer, Im glad I had a choice of which hospital he was treated at, and you progs want to take that choice away. What I find funny is you libs are pro choice but we cant chose our own healthcare? Hypocritical.

Contango

Re: "You aren't going to obey the law...Fine by me!"

Approx. 30% of drivers in large states like TX and CA have no mandated auto ins.

Better be building a lot of debtors' prisons to hold the scafflaws that don't have mandated health ins.

meowmix

No prisons needed Contango--they'll just be missing a few hundred $'s from their income tax refund.

Also, rbenn-- you must have had (and still should have) great insurance that won't be affected by the ACA if you had an option of where to take your child. So why the problem? Where did you take your child to be treated?-and is it one that is not going to take your insurance? Or, were you eligible for medicaid? Big difference.

Contango

Re: "income tax refund."

lol

What percentage of Americans now pay federal income tax?

Any wonder why more and more low-income people are being paid "under the table"?

The major mental fallacy with central planning bureaucrats is that they think that they're smarter than everybody else.

Free markets and free people!

deertracker

Stop making stuff up just to type something pooh. People are paid under the table to mostly benefit the employer. If the employee does not pay taxes because he is paid under the table, the employer does not either. That part seems okay to you.

You think you are always the smartest guy in the room but you are not.

Contango

Re: "People are paid under the table to mostly benefit the employer."

So the worker doesn't like getting tax-free money? You're FOS.

--------------------

Re: "You think you are always the smartest guy in the room but you are not."

lol

And you obviously think that you're too stupid to make your own socio-economic decisions and need some bureaucrat to make them for you.

You're right. :)

grumpy

Re: "What percentage of Americans now pay federal income tax?"

Better question would be how many don't pay federal income tax but get a refund anyway?

The Hero Zone's picture
The Hero Zone

Modify it to include illegal immigrants if we are taking a look. Didn't the GAO say a few billion was paid out to non-citizens who may never have paid anything (net) in taxes?

grumpy

Point taken. Only ways to stop that would be to enforce the border and current laws pertaining to immigration... or have a federal sales tax instead of income tax (much like Bill Gates suggested) or a flat tax where you can just fill out a post card sized tax return and pay a set percentage, no deductions. I would be happy with any of those.

The Hero Zone's picture
The Hero Zone

The sick part was that if I remember correctly a certain party used the closure of that "loophole" paying non-citizens as a compromise issue in budgetary talks. They would support not paying money to those who aren't entitled to it in exchange for some concession from the other party. Meanwhile every American regardless of affiliation loses.

I am all for either option, though favor the sales tax approach. I won't even follow it up with a negative qualifier or "but..." statement. Changing our tax system is imperative and will be more "fair" to the citizens while also collecting untold windfalls of revenue to actually fund the programs we have even if they are wasteful pork and/or pet projects.

SamAdams

I'd opt for the sales tax as defined by the FairTax folks. It would simultaneously eliminate both the individual and the corporate income tax, but would ensure that everybody who buys things pays taxes. Companies would pay taxes (finally!), individuals (including those here illegally) would pay taxes. Those of us who currently pay taxes would see an effective decrease, while the government would see an INCREASE in revenue. What's not to like? Unless you're an IRS thug, I mean...

The Hero Zone's picture
The Hero Zone

There are those points and the fact that let's say I curmudgeonly didn't want to pay taxes then I could...grow my own food! Build my own birdhouse! Utilize trade/craft skills, learn to garden, and such. Plus, it would increase competition among businesses as after a certain point the extra tax on the price would make the final total substantially different.

It would also mean that D.C. would want/have to foster an environment that opens up a marketplace, focuses on teaching policies and business practices in school, and allows consumers to innovate themselves or support those businesses that already do.

The amount of manpower and paperwork spent on taxes will dramatically decrease, allowing us to actually be more productive as a society. Under the table jobs wouldn't matter nor "drug money", save for where you must offer proof of income through check stubs etc.

Contango

Re: "could...grow my own food!"

The Supreme Court has ruled that the State can prevent you.

http://en.wikipedia.org/wiki/Wic...

rbenn

Cleveland clinic, but what Im getting at it isn't about me, its about others down the road that wont be able to utilize the services of these hospitals. I am fortunate to have good insurance but when the employer mandate hits I may lose that coverage. This law was ill conceived and many will have sub standard care. And when its all said and done 30 million people will still be without coverage. CBO has said that many times

deertracker

If you lose your coverage from your employer they will recommend you get Obamacare!

rbenn

I will never purchase obamacare!

deertracker

I don't care what you do!

grumpy

Every post you make about obamaScare shows the lie in your statement.

ladydye_5

Eventually everyone will lose their employer coverage and be forced into Obamacare. Sad part is Obamacare is WAY over priced and it SUCKS. In no way is it affordable. I have family that just went thru the whole fiasco and it is ridiculous. For low income it is unaffordable and unbelievably horrible coverage.

MiddleRight

Typicall liberal. Your argument is trash so you refer to "teatards" and "contempt for the current administration".
Just admit this law is trash and a horrible idea. I don't care who came up with this. Pelosi said pass it to find out what's in it. Well, know we know. Higher premiums, lower access, and higher deductibles. Just about what you expect from gov't interventions.

kURTje

So who pays for those that do not pay / will not pay...errrrr. US.

meowmix

Absolutely--kURTje! It's just they don't care for the black boogie man in the WH telling them to be responsible for themselves.

Contango

Re: "telling them to be responsible for themselves."

What? It’s not all gonna be FREE???

If people are that stupid, to need some former community organizer to lecture ‘em about responsibility, this country is in serious sh*t.

Put a fork in it – it’s done!

deertracker

Your words pooh but they are true. People aka some Americans need to be told what to do. On one hand you and yours preach about personal responsibility then cry foul when the President preaches it. What gives?

Contango

Re: "some Americans need to be told what to do,"

Would expect an Obambot like yourself to think nothing less.

Pres. Obama isn't "preaching" responsibility but rather dependency.

Remember: Obamacare is a TAX.

You're as ignorant as ever.

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