The Evolving Health Care Landscape and the Oncologist’s Role in Policy Engagement

Summer marks a season of change—training programs begin, diplomas are earned, and first jobs get underway. Regardless of whether one is staying in place or changing locations, 2026 has been an impactful year and will continue to be so. It is common to focus on our craft, the science, and the bedside relationships. But what about the tangential relationships that have the power to shape medicine as a whole? How do we focus on these relationships, and why is this important?

It is recognized that health care has become increasingly politicized over the past 5 to 6 years. In truth, the politicization of health care began long before the COVID-19 pandemic. We just didn’t realize it, because we were not involved. Over the course of decades, the independent practice has become endangered. Hematology/oncology practices are increasingly owned by corporations or by hospitals, which are increasingly owned by corporations. Additionally, the insurance industry has taken a front seat in curbing health care costs. Still, the practical reality of what it means to treat cancer patients is not always a priority for an insurance algorithm.

For years, our field has dismissed these developments as "noise"—a distraction from what matters most: patient care. Unfortunately, over the decades, we have ceded our control to regulatory bodies, insurance companies, and corporations and have lost our voice in health care matters that affect our patients with cancer. So, the question becomes: How do we increase our control to influence large health care decisions and policy? This is not about one political party or the other because care of patients with cancer should not be partisan. And if that focus remains our north star, then our involvement in the evolution of influence in the field should be increasing accordingly. But this takes effort.

Our professional societies do a wonderful job of hosting advocacy days in Washington, DC. That is a fantastic way to get involved and learn best practices for engaging with legislators. However, as more states pass state-specific health care legislation, impact also comes from local advocacy. Right now, in my state, there is legislation that aims to mitigate the effects of pharmacy benefit managers (PBMs) on physicians’ freedom to prescribe appropriate cancer-directed therapy at the right time while minimizing patient costs and allowing hospitals or other outside pharmacies to provide the recommended medications. This legislation has taken years (approaching 10) to come to fruition and would not be where it is today without our American Society of Clinical Oncology (ASCO) state society involvement.

The PBM situation is quite complex, but it highlights an area in which physicians have ceded control of their time through increased prior authorizations with certain PBMs and their freedom of medical decision-making. However, this situation also demonstrates that sustained and dedicated effort can impact industries and lobbying powers to which our power has been ceded over time.

In addition to national and state professional societies, there are other ways to get involved. The American Medical Association (AMA) is another great example. The AMA has a significant relationship with the Centers for Medicare & Medicaid Services, and thus AMA resolutions can directly impact national policy. Examples of recent resolutions supported by the ASCO-AMA delegation include addressing coverage for medically necessary dental services for cancer care, Medicare Advantage Part B drug coverage, and prohibiting mandatory white bagging. After attending a few AMA meetings, I can vouch that this is a fascinating immersion into a well-orchestrated event that mimics the same process as our federal government, from writing resolutions to testifying to passing bills.

For those who do not have the bandwidth to be involved at these levels, please register to vote. Vote in local elections and national elections. Midterms are coming, and everybody’s voice must be heard. Hematology/oncology is a large subspecialty. We may not agree on which candidate best represents our cities, counties, and nation, but our control over our future as citizens and as physicians is ceded if we don’t even show up to vote. The consequences are tremendous for the preservation of our field and our health care freedom.