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Health Policy Director Discusses ACCC's Take on ACA Repeal, MedPAC's Part B Recommendations

Shannon Connelly
Published: Friday, Apr 28, 2017

In the wake of the Affordable Care Act (ACA) repeal bill, the Association of Community Cancer Centers (ACCC) is concerned with maintaining the critical patient protections of the law, says Leah Ralph, director of health policy for the ACCC.

In an interview with OncLive, Ralph discussed the ACCC’s position on the ACA repeal bill, the Medicare Payment Advisory Commission’s (MedPAC) Part B cost control proposals, and the possibility for comprehensive reform on the 340B Drug Discount Program.

OncLive: Can you discuss ACCC’s take on the latest GOP proposal to reform healthcare?

Ralph: In recent days, we have seen some negotiation between the heads of the Freedom Caucus and the moderate Republican group on the House side and there is an effort to find a path forward on the ACA repeal bill. The new amendment language that we have seen allows states more flexibility to implement a lot of the insurance provisions in the ACA—things like essential health benefits and community health ratings. It's allowing states to apply for waivers to allow insurers to opt out of those requirements. 

 ACCC's position on the ACA repeal bill is that we want to maintain those critical patient protections that are in the bill that seem particularly critical for cancer patients who, inherently, can't predict what their out-of-pocket costs will be. That population needs access to comprehensive, affordable health insurance coverage.

There are some concerns with the new amendment that would change the underlying American Health Care Act (AHCA) that we have seen. It's unclear at this point how many states would apply for these waivers or what the impact would be. But there are concerns about undermining a lot of those patient protections that we have gained in the ACA.  

How does the ACCC view the MedPAC proposals for Part B cost control, particularly the proposed third-party vendor price negotiations?

In early April, we saw MedPAC come out with a series of recommendations around Part B reimbursement—these are policies that we have seen MedPAC, as a group, discuss in the past. Not a huge surprise, but the recommendations fall into 2 buckets. The first is what they are calling an improved Average Sale Price (ASP) reimbursement system, and the second bucket is a proposal for what they are calling a Drug Value Program, which is essentially, in some ways, a modified version of the Competitive Acquisition Program that was in effect from 2006 to 2008.

At ACCC, we are committed to working with Congress and with Centers for Medicare and Medicaid Services (CMS) to make sure that we can develop a healthcare system where cancer patients can receive access to the drugs they need. We are also committed to finding a way forward on a less costly system for patients and for providers of the Medicare program. I think there is not enough detail in the Drug Value Program proposal for us to understand what that looks like and what the impact would be on patients and providers. 

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