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

The summer is a time of transition, starting a training program, graduations, first jobs and more. Regardless of whether staying in place or moving location, 2026 has been an impactful year and will continue to be so. It is common to focus on our craft, the science, 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. But in truth, the politicization of health care went on way before the COVID-19 pandemic. We just didn’t realize it and 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, but the practical reality of what it means to treat cancer patients is not always a priority for an insurance algorithm.

As a field, we have viewed these developments over many years as “noise” which distracted from the most important business at hand, taking care of the patient. Unfortunately, over 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 the cancer patient 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 to learn best practices for how to engage 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 is trying to mitigate the effect of pharmacy benefit managers (PBMs) on physician freedom to prescribe appropriate cancer-directed therapy at the right time while minimizing patient cost and allowing the hospital 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. But this situation also demonstrates that sustained and dedicated effort can impact industries and lobbying powers to whom 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 way to get involved. The AMA has a significant relationship with 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 dental services that are medically necessary for cancer care; Medicare Advantage Part B drug coverage; and prohibiting mandatory white bagging. Having attended a few AMA meetings, I also can vouch that this is a fascinating immersion into a well-orchestrated event that imitates the same process as our federal government from writing resolutions to testifying to passing bills.

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