A few weeks ago I was invited to the White House and the Capitol to discuss the status of cancer care after the Affordable Care Act implementation and the Moonshot initiative. Importantly, World Cancer Day on February 4 has given us the added incentive to examine just what has happened to cancer care under the Obama administration.
Under the leadership of President Obama, the Affordable Care Act (ACA) widely known as Obamacare, and the Beau Biden Moonshot Program, led by Vice President Joe Biden, have greatly impacted our war on cancer. This war on cancer started 46 years ago when President Richard Nixon announced a cancer research and treatment goal in his January 1971 State of the Union address. It culminated in December 1971 when he signed the National Cancer Act of 1971 “The War on Cancer.” By revolutionizing the National Cancer Institute (NCI) and Food and Drug Administration (FDA), the war on cancer resulted in research and treatment advances that have decreased cancer death rates by 20 percent and helped increase the length and quality of lives of Americans.
At the Whjte House, representatives of American oncology and the president’s and vice president’s staffs noted how the ACA has helped cancer patients to access needed treatments by increasing the number of people with health insurance. According to a presentation of the American Cancer Society at the White House, this has decreased breast cancer mortality by 10 percent to 40 percent (larger reductions in states which have expanded Medicaid apparently). Further, the ACA has helped cancer survivors by making sure that they are able to get health insurance by eliminating the pre-existing condition exclusion, which before the ACA always made it impossibly difficult to get health insurance once cancer had been cured. As well, cancer screening tests are covered by the ACA, making it possible to diagnose and treat cancers when they are detected at smaller sizes which are more curable.
Also, the Beau Biden Moonshot program has increased the possibilities for further improving cancer cure rates and cancer prevention. Moonshot has already improved the ability of the FDA to more rapidly evaluate new cancer treatment and tests, which will bring important advances to patients more rapidly. Funding is also aimed at expanding cancer research to identify genetic targets for therapy, further refining cancer genome analysis and sharing those results nationally to determine which are new leads and which are unimportant, and using new drugs and patients’ own immune cells as immunotherapy to fight cancer without chemotherapy side effects. Importantly, Moonshot also focuses national support for cancer risk assessment, cancer prevention and cancer screening in Americas communities.
Why was the White House meeting important at this time? Cancer care and cancer research has been improving, but with the change from an Obama administration to our new Trump administration, will this beneficial trajectory of improvement continue? The answer is mixed. The ACA is due for repealing, replacing, or repairing. All Americans are hoping that even more people will be able to be covered by health insurance, and will want to purchase insurance, and everyone wants the prohibition on pre-existing exclusions to continue. But everyone also wants insurance to be more affordable, so which programs will survive the coming changes, and which cancer care elements will be sustained and hopefully expanded? Stay tuned for the fast and furious improvements, which we hope will be positive. Representatives of oncology at the White House could not be sure.
At the same time, our discussions with the authors of the 21st Century Cures Act Congressman Fred Upton and Congresswoman Dianne DeGette reassured us that the 10 year funding of programs in the Moonshot initiative would continue in the new Trump administration. The Cures Act passed with overwhelming bipartisan support and resulted in $1.8 billion for the Moonshot (announced by President Obama in his January 2016 State of the Union address) and also $1.5 billion for the Precision Medicine Initiative (announced by President Obama in his January 2015 State of the Union address). These funds are already in the hands of the federal agencies, which will use the resources to support nation-wide projects that accomplish the cancer-care program goals already approved by the Moonshot Task Force and Blue Ribbon Panels over the past year. Progress is expected.
So here are my tips for you to help you with cancer issues in light of World Cancer Day, the ACA, and the Beau Biden Moonshot program.
· Since access to health insurance may be more difficult in the future, be sure to have and keep health insurance starting now. Stay insured so you are not challenged by pre-existing condition exclusions.
· Once you have health insurance, be sure to ask your doctor to order cancer screening exams, do cancer risk assessments and begin cancer prevention (which are all covered now, but uncertain in the future).
· If you have cancer, ask your physician for a plan of treatment that you can understand. Ask if the treatment she/he has proposed can be better if you participate in a clinical trial, which can sometimes make the newest therapy available to you.
· Ask if your cancer has undergone genomic evaluation, which can help the oncologist plan the most precise treatment for you. These tests will become more available with the Moonshot program, but can be ordered in most hospitals today. If your doctor does not know, get a second opinion. For advice on different types of second opinions, and where to get them, see my website and book Surviving American Medicine. Get second opinions now before possible changes in insurance restrict the networks of physicians available to you.
· If you are a cancer survivor, make sure your oncologist has given you a Survivorship Plan, which gives you all the details on how to prevent second cancers, reduce any side effects from your cancer treatments, and reduce the chances of your previous cancer coming back. If your doctor does not have one for you, get a second opinion. By having and using your survivorship plan, if there are changes in your doctors due to insurance reforms, your new physicians will know what was done in the past, and what needs to be ordered now and in the future to keep you healthy and happy.
We have made progress in the war on cancer over the last 8 years, and we hope that this progress continues as we improve the ACA and implement the Beau Biden Moonshot Program. Also let your congressmen and senators know you support their commitment to cancer care.