Cancer patients can get coverage under health care law, but some of best hospitals off-limits

Administration: Networks will get closer scrutiny next year

By Ricardo Alonso-Zaldivar

Associated Press

Published: Wednesday, March 19 2014 7:53 a.m. MDT

In this March 23, 2010, file photo President Barack Obama is applauded after signing the Affordable Care Act into law in the East Room of the White House in Washington.

Charles Dharapak, Associated Press

Enlarge photo»

WASHINGTON — Cancer patients relieved that they can get insurance coverage because of the new health care law may be disappointed to learn that some the nation's best cancer hospitals are off-limits.

An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington state's insurance exchange. MD Anderson Cancer Center says it's in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.

Doctors and administrators say they're concerned. So are some state insurance regulators.

In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP's survey said patients have access through all the insurance companies in their state exchange.

Not too long ago, insurance companies would have been vying to offer access to renowned cancer centers, said Dan Mendelson, CEO of the market research firm Avalere Health. Now the focus is on costs.

"This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans," Mendelson said.

Those patients may not be able get the most advanced treatment, including clinical trials of new medications.

And there's another problem: It's not easy for consumers shopping online in the new insurance markets to tell whether top-level institutions are included in a plan. That takes additional digging by the people applying.

"The challenges of this are going to become evident ... as cancer cases start to arrive," Norman Hubbard, executive vice president of Seattle Cancer Care Alliance, said.

Advocates for cancer patients are in a quandary.

Before President Barack Obama's health care law, a cancer diagnosis could make you uninsurable. Now, insurers can't turn away people with health problems or charge them more. Lifetime dollar limits on policies, once a financial trapdoor for cancer patients, are also banned.

"Patients may have fewer choices of doctors and hospitals in some exchange plans than others ... but the rules for such plans go a long way toward remedying the most severe problems that existed for decades," said Steve Weiss, spokesman for the American Cancer Society Cancer Action Network.

The new obstacles are more subtle.

To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans.

By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere.

For now, the issue seems to be limited to the new insurance exchanges. But it could become a concern for Americans with job-based coverage too if employers turn to narrow networks.

The AP surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network. Two additional institutions that joined this week were not included in the survey.

Cancer network members are leading hospitals that combine the latest clinical research and knowledge with a multidisciplinary approach to patient care. They say that patients in their care have better-than-average survival rates. The unique role of cancer centers is recognized under Medicare. Several are exempt from its hospital payment system, instituted to control costs.

The AP asked the centers how many insurance companies in their state's exchange included them as a network provider.

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