An Update From the States

An Update from the States

In an ongoing effort to keep you up to date on the many proposed and approved changes to our health care system and how they might impact the cancer community, this week, we bring you updates from around the country. If you don’t live in one of these states, be aware, these changes could come to your state next. 

Medicaid News:

Do you have Medicaid coverage? You can now access the services included in Amazon Prime for a discounted fee of $5.99 a month, less than half the regular cost of $12.99 a month. Access to Prime services, including free expedited shipping, can be particularly useful for someone who is treatment. Instead of having to go grocery shopping or running other errands for household items, Amazon Prime can deliver those items to your doorstep for free. Amazon also now offers electronic benefit transfer (EBT) cards, which are used for food stamp benefits.

Other National News:

In the recent Bipartisan Budget Act of 2018, passed by Congress on February 9th, there were several changes made to our health care system that may be helpful and challenging for the cancer community:

  1. It provided two additional years of funding to State Health Insurance Assistance Programs (SHIP) and Area Agencies on Aging, which are two valuable resources that help seniors manage their Medicare coverage and get access to other programs and services.
  2. It eliminated the Medicare cap on access to outpatient physical, occupational, and speech therapy services as of January 1, 2018.
  3. It closed the Medicare Part D donut hole one year earlier in 2019, lowering the cost of prescription drugs for people with Medicare.
  4. It also changed the way that Medicare pays for home health services beginning in 2020. The home health coverage will be reduced from 60 days to 30 days and therapy thresholds will be eliminated. Beginning in 2019, Medicare will be allowed to base eligibility for home health services on a review of a patient’s medical record, including a home health agency’s record.


The Hawaii House has approved a bill that would allow physicians to prescribe life-ending medication to terminally ill patients. The bill now moves to the Senate, which approved a similar bill laws year. If approved, Hawaii would join California, Colorado, Oregon, Vermont, Washington, and the District of Columbia, which have death with dignity laws. Click here for more information about state laws.


A few weeks ago we shared that the Idaho Governor announced that he will allow insurance companies to sell plans in violation of the Patient Protection and Affordable Care Act (ACA). The ACA required health insurance plans to meet certain minimum requirements in order to protect consumers from pre-existing condition exclusions and annual and lifetime limits, while ensuring coverage of essential health benefits.

This past week, the Trump Administration did reject Idaho’s plan to sell plans in violation of the ACA.  Many other states had been closely watching this decision, as they also were looking at allowing plans without the ACA consumer protections. The cancer advocacy community was pleased to see that these consumer protections wouldn’t be ignored. However, the Administration did suggest to Idaho that they instead promote the sale of short-term insurance plans. Click here for more information on these plans.


The Iowa Senate voted last week to let the Iowa Farm Bureau Federation and Wellmark Blue Cross & Blue Shield sell health insurance plans that don’t comply with the ACA, allowing people with pre-existing conditions to be denied or charged more for coverage.  Given the Administration’s rejection of Idaho’s plans, it is likely that Iowa will not be able to move forward with the sale of these plans.


There was a question as to whether or not Arkansas’ legislature was going to keep their expanded Medicaid program. However, lawmakers did vote to keep the program that covers 285,000 people in Arkansas another year.

In addition, the Trump Administration has approved Arkansas’ request to add a work requirement to their Medicaid program, joining Indiana and Kentucky as states that have added this new requirement. There are seven other states that have submitted applications for a Medicaid work requirement and 14 other states that are considering it.

Stay tuned for the latest news  . . .

Is Short-Term Insurance the Solution?

Last week, we shared a number of changes that states are looking to make to our health Short term health insurance policy on a table. care system. This week, we bring you a major change that has been proposed nationally.

Short-Term Insurance Plans

First, the U.S. Department of Health and Human Services (HHS) has released a proposed rule to allow the sale of short-term health insurance plans with coverage for any period less than 12 months.

Short-term health insurance plans are plans that only provide coverage for a certain period of time, less than a year. These plans were only intended to provide coverage for people who were between jobs or needed temporary coverage for other reasons.

These plans are not required to comply with the ACA’s consumer protections, which means that they can deny people with pre-existing conditions, can require people to complete medical questionnaires on the application, can charge people more because of an individual’s health history, and do not have to cover essential health benefits.  For example, a plan could exclude mental health care, preventive care, substance abuse treatment, or maternity care. They also are not required to have an out-of-pocket maximum, which means that people with serious medical conditions like a cancer, will pay significantly more for their medical expenses.

Because they don’t have to comply with these consumer protections, these plans are often referred to as “junk insurance.” These plans generally appear cheaper than other individual health insurance plans. The lower monthly premiums make them attractive for people who are healthier.  However, cancer is unpredictable.

The other challenge with these short-term plans, is that when they end, they do not have ‘guaranteed renewability.’  This means that an insurance company does not have to offer an individual a new policy when the term of coverage ends.  Furthermore, because these plans do not comply with the ACA, they are not creditable coverage. So when they end, it does not trigger a special enrollment period to buy a plan in the Health Insurance Marketplace. If no other coverage is available (e.g., going on a parent’s plan if they are under 26 years old), someone who has been diagnosed with cancer may have to wait for coverage until the next open enrollment period.

HHS’s previous rule from 2016, limited these short-term insurance plans to a maximum of three months. HHS is now allowing these plans to last for any time period up to 12 months, meaning that they can last up to 364 days.

Advocates have three main concerns about this change:

  1. Unsuspecting consumers who are healthier will leave the Marketplace to buy these cheaper plans, which will drive up the costs of plans in the Marketplace
  2. If these healthier individuals are diagnosed with serious medical conditions, they may find they are not adequately covered by their short-term plan and may lose access to insurance when their term ends
  3. People with pre-existing conditions won’t be able to purchase these cheaper short-term plans, which means they will be stuck in the marketplace with more expensive plans

While expanding access to these short-term plans does increase the number of options available to consumers, there is a concern that the expansion of these plans allows insurance companies to do another end run around the consumer protections laid out in the ACA, ultimately leaving consumers with less coverage and more cost.

People have until April 23, 2018, to comment on this proposed rule, and then HHS will release a final rule at some point after that. We will keep you posted. Stay tuned.

Congress Takes Steps to Undermine the ADA

Many have heard of the Americans with Disabilities Act (ADA), but may not know all of the details. The ADA is the federal law that protects people with disabilities from discrimination in a variety of ways.

The ADA was passed by Congress in 1990, more than 28 years ago.  Congress improved protections in the ADA in 2008 by passing the ADA Amendments Act.  Most people are familiar with its physical access requirements, such as having accessible parking spots, ramps into buildings, and accessible restrooms. However, despite its age, many who are protected by the ADA, don’t know it.

In addition to physical access requirements, the ADA also provides protections for people with disabilities in the workplace.  Title I of the ADA requires that covered employers provide eligible employees with protection against discrimination and rights to privacy, as well as access to reasonable accommodations. For more information about these protections and how they apply to individuals diagnosed with cancer AND their caregivers, visit:

The ADA also provides protections for children, adolescents, and young adults with disabilities in school, including those diagnosed with cancer.

Approximately 36% of adults ages 65 and over have some type of disability. Learn 7 facts about Americans with disabilities.

This month, Congress took a step to erode the protections in the ADA.  The U.S. House of Representatives passed (252-192) the ADA Education and Reform Act, which forbids individuals with disabilities from suing a business for violating their rights under the ADA, unless they first:

  1. Provide written notice to the business that they are in violation of the ADA
  2. Wait 6 months to see if the business fixed the violation

Opponents of the bill argue that this allows businesses to refuse to comply with the ADA, until an individual with a disability sends them a written complaint and then they get another 6 months to comply. Meanwhile, the individual with a disability is unable to access that hospital, doctor’s office, restaurant, store, movie theater, hotel, or other public place.

Advocates for people with disabilities are skeptical that businesses need more time to comply with a law that was enacted almost thirty years ago.

In what other area of society do we allow a business to ignore a law until someone sends them a written complaint?

Oh, wait.  That sounds a lot like health insurance appeals.

The bill now awaits a vote in the U.S. Senate. For more information about how to be an effective advocate, visit Stay tuned.




2015 Cancer Legislation

Many laws exist to protect individuals coping with cancer, however, there is still more Triage Cancer Advocacythat can be done to improve patient care and protect patients with cancer. This is where advocacy comes into play. The following pieces of legislation are currently pending in Congress and are relevant to those coping with cancer, their caregivers, and their health care professionals.

The Cancer Drug Coverage Parity Act (H.R. 2739/S. 1566), bipartisan legislation that would require private health insurance plans offering intravenous cancer drug benefits to provide parity, or equal coverage, for orally administered and self-injectable cancer drugs. The bill was introduced this summer but no other action has been taken in either the House of Representatives or the Senate.

The Patients’ Access to Treatment Act (H.R. 1600) would establish limits on cost-sharing for health insurance plans that cover prescription drugs and use a formulary or other tiered cost-sharing structure. In other words, this bill would prohibit health insurance companies from charging consumers more for specialty drugs than for other prescription drugs. This bill was introduced in March 2015, but no action has been taken in the House of Representatives.

The 21st Century Cures Act (H.R. 6) would provide new funding for the National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA). This funding would allow these entities to addresses the issues around information blocking and working to improve the interoperability of electronic health records (EHRs) and to support precision medicine and other areas to accelerate cures and improve cancer care. This bill has passed in the House of Representatives and is currently awaiting action in the Senate.

The Childhood Cancer Survivorship, Treatment, Access, and Research (STAR) Act (H.R. 3381/S. 1883) would track childhood cancer incidence and improve survivors’ quality of life. The goal of the bill is to accelerate the development and availability of promising childhood cancer treatments. This bill was introduced in the House of Representatives and the Senate in July 2015 and has been referred to health subcommittees, but no other action has been taken.

The Planning Actively for Cancer Treatment (PACT) Act (H.R. 2846) would provide coverage for cancer care planning and coordination under Medicare. This change would provide individuals with Medicare and their healthcare providers resources to ensure that a clear cancer care plan is developed and assessed throughout all cancer-related care. This bill was introduced to the House in June 2015 and no further action has been taken.

For more details about any of these bills, visit

If you would like to get involved in advocacy but aren’t sure how, consider joining another organization’s efforts. For example, if you sign up for ASCO’s Act Network you will get alerts when cancer related legislation is being discussed or voted on in Congress and you are able to send messages using the pre-drafted editable alerts, find the contact information for your elected officials, see how your member of Congress votes on the key issues, and draft your own messages to email or send a letter to your member of Congress. The American Cancer Society Cancer Action Network (ACS CAN) is another resource to help you participate in legislative advocacy. ACS provides pre-drafted messages that can be personalized for you to share with your government representatives.

Triage Cancer has an entire webpage dedicated to helping you engage in advocacy efforts and even includes the social media handles for several elected officials to make it easier to engage with your members of Congress online. Not sure how to use social media? Triage Cancer teamed up with Living Beyond Breast Cancer to provide a webinar on Twitter as An Advocacy Tool. We will also be hosting our very popular webinar on how to be an effective advocate in early 2016. Sign up for our newsletter for updates to our webinar schedule.

You can make a difference in the lives of those coping with cancer, so write an email, send a letter, make a phone call, or even tweet at your local officials and make your voice heard today!