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Issue
Affordable Health Care for America Act
– House Bill
Patient Protection and Affordable Care Act
– Senate BillWhy This is Important
Prevention and Screening Services
Co-pays for preventionand screening servicesEliminates co-pays for all preventiveservices (including colorectal cancer screening) that have a United StatesPreventive Services Task Force(USPSTF) A/B rating, and requirescoverage of these tests by privateinsurance.Waives all Medicare co-pays (both co-insurance and deductibles) for preventiveservices.Requires state Medicaid programs tocover (without co-pays) preventiveservices that are recommended by theUSPSTF and appropriate for Medicaid beneficiaries.Eliminates co-pays for all preventiveservices (including colorectal cancer screening) that have a United StatesPreventive Services Task Force (USPSTF)A/B rating, and requires coverage of thesetests by private insurance.Waives co-pays for most preventiveservices, requiring Medicare to cover 100 percent of the costs. Services for which noco-pays or deductibles would be requiredare the personalized prevention planservices and any covered preventive serviceif it is recommended with a grade of A or B by the USPSTF.Allows the Secretary of Health and HumanServices (HHS) to withdraw Medicarecoverage for a service not rated as A, B, C,or I by the USPSTF.Eliminating co-pays for preventivecolorectal cancer screening will lower thecost of screening services for individualswhich will help to increase population- based screening rates.Funding for publichealth activities(including preventivescreenings)Establishes a Prevention and WellnessTrust. Authorizes $15.4 billion infunding over FY2011-FY2015 to fund prevention task forces, preventionwellness research, delivery of community-based prevention andwellness services, and core public healthinfrastructure and activities.Establishes a prevention and public healthfund to be administered through the Officeof the Secretary at the Department of HHSto provide for an expanded and sustainednational investment in prevention and public health programs. This new fund willsupport public health activities including prevention research and health screenings.Also has a section regarding community preventive screenings, and specifically listscancer screenings as one of the communityinterventions needed to improve publicFunding for initiatives that incorporatecolorectal cancer screening are important toincreasing population-based screeningrates.
Issue
Affordable Health Care for America Act
– House Bill
Patient Protection and Affordable Care Act
– Senate BillWhy This is Important
health.United StatesPreventive ServicesTask Force (USPSTF)Converts the existing USPSTF into the“Task Force on Clinical PreventiveServices.” The task force is charged withconducting evidence based systemicreviews of data and literature todetermine which clinical preventiveservices (i.e., preventive servicesdelivered by traditional health care providers in clinical settings) arescientifically proven to be effective.Defines clear duties for both the USPSTFand the Task Force on CommunityPreventive Services (the Task Force onCommunity Preventive Services is anexisting task force that deals with preventive programs and services outside of the doctor-patient relationship).Provides for better coordination betweenthe two task forces.The United States Preventive Services Task Force (USPSTF) is the entity that setscreening guidelines for colorectal cancer.
Affordability of Care
Annual and lifetimelimits No annual or lifetime limits for benefitsoffered under the “essential benefits package.”Sets limits on maximum annual co-pays -$5,000 for an individual and $10,000 for a family.Eliminates “unreasonable annual” limitsand lifetime limits on the dollar value of benefits for any participant or beneficiaryfor all group health plans and healthinsurance coverage required to provide“essential health benefits” (i.e., anyinsurance company or plan that participatesin the new health insurance exchange).Many colorectal cancer patients face alifetime of cancer treatment. Caps oninsurance result in very difficult decisionsabout the care they will receive and howthey are going to pay for it.
Affordability of Insurance
High-risk poolEstablishes a temporary three year highrisk plan to help those currentlyuninsured gain coverage. Includessubsidies for those under 400% of thefederal poverty level. Provides $5 billionto fund this program.Establishes a temporary four year high risk health insurance pool to provide coverageto individuals until Jan. 1, 2014. Provides$5 billion to fund this program.Many of the provisions in both the Houseand Senate bills will not take effectimmediately. Establishment of a high risk insurance pool will help those individualswith pre-existing conditions afford healthinsurance until the provisions in the billeliminating pre-existing conditionexclusions take effect.
Issue
Affordable Health Care for America Act
– House Bill
Patient Protection and Affordable Care Act
– Senate BillWhy This is Important
Pre-existing conditionsexclusions No denial of coverage based on pre-existing health conditions in the plan.A group health plan and a health insurer offering individual or group insurance maynot impose any pre-existing conditionexclusion with respect to such coverage.Eliminating pre-existing conditionsexclusions is very important for cancer patients. Pre-existing condition exclusionslock the millions of Americans with at leastone chronic illness (nearly one third of the population) into existing plans andemployment.C3 supports shortening the timeframe for the elimination of pre-existing conditionexclusions and waiting periods for allindividuals in every health insurancemarket to ensure access to care.Specifically, C3 supports shortening theimplementation timeframe to allow it to begin in single insured and small group plans in 2010 and to completeimplementation with large group and self-funded plans in 2011.
Expanding Access to Insurance
Increase number of Americans with accessto health insuranceCreates a public option, financed through premiums. It would use negotiated ratesno lower than Medicare rates.Beginning in 2013, permanent privatehealth insurance market reforms wouldgreatly benefit cancer patients andsurvivors including the establishment of a national health insurance exchangewhich would enable individuals whocannot get insurance through their employer to comparison shop.Creates a “community health insuranceoption” and allows states to opt-out of the plan. Requires the HHS Secretary tonegotiate provider reimbursement rates nothigher than average rates paid by private plans.Increasing the number of Americans withhealth insurance will help reduce mortalityrates from colorectal cancer. Many studiesshow that people who are uninsured aresubstantially less likely to be screened for colorectal cancer. In addition, insurancestatus strongly influences survival amongthose diagnosed with colorectal cancer – individuals with private insurance who arediagnosed with stage II colorectal cancer have better survival outcomes thanindividuals who are uninsured and arediagnosed with stage I colorectal cancer.
What Services and Treatments Will Be Covered
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