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Kenneth Thorpe

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Stop a Violation of Health Care Reform in Oregon

Posted: 09/27/2013 6:37 pm

Moving squarely against the Affordable Care Act's objective of providing comprehensive health insurance for all Americans, Oregon has made a disconcerting move to restrict access to care for those who need it most -- low-income, cancer patients.

In August, Oregon's Health Evidence Review Commission (HERC) voted to approve Revised Guideline 12, Cancer Care Near the End of Life. As a result, starting October 1, patients on Medicaid will not receive life-saving cancer medications if they have certain HERC-determined symptoms. If this reminds you of the so-called 'death panel' debate back when health care reform was being debated, you are not alone.

I support the ACA and its goal of providing health care coverage to those who are uninsured or under-insured. In states that choose to expand Medicaid, the ACA helps provide insurance to individuals who earn up to 138 percent of the federal poverty level. This means many people -- disproportionately minorities -- who were struggling previously to afford health insurance, but earned too much to qualify for Medicaid now have access to health care through the program.

Oregon is among the states that have rightly decided to accept federal funding to expand their Medicaid program. They are also innovators in the use of team-based health care to provide whole person care to Medicaid patients with multiple chronic health conditions. Yet, at the same time, Guideline 12 will violate a core principle of the ACA that forbids the restriction of access to "essential health benefits" based on disease, condition, projected length or quality of life.

Furthermore, the Guideline will take clinical decision making out of the hands of doctors and deprive patients their best chance of fighting cancer. The HERC's determination of which symptoms exclude a patient from curative treatment is not even based on medical literature or best clinical practices, but rather the odds of survival observed in groups of patients.

I am concerned that a group of state officials -- not health care professionals -- are making these decisions. It should not be up to the state commission to decide which cancer patients in the state can receive treatment and which patients should be left to die based on arbitrary estimated survival rates. The cancer treatment landscape has come so far and those with the greatest medical needs should have access to the potentially life-saving therapies that their doctors prescribe.

We have an unprecedented opportunity before us to offer care and treatment access to all Americans, but it is essential that the proper checks and balances are in place to ensure we are embodying the full spirit of the ACA in its implementation.

As the government agency responsible for authorizing Medicaid expansion federal funds, the Centers for Medicare & Medicaid Services should stop Oregon from moving forward with Guideline 12. For our patients, their families and generations to come -- there is no time to waste. And if action is not taken, shame on us.

 

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