What a Continually Divided Congress Means for Community Oncology

Sydney Abbott, JD
Policy Coordinator, Association of Community Cancer Centers

The Association of Community Cancer Centers (ACCC) held its 39th Annual Na­tional Meeting for members March 6-8, 2013. The day after ACCC members went to Capitol Hill to participate in nearly 120 scheduled meetings with members of Congress, a panel of 3 policy specialists discussed the current political climate and the probability of oncology-related legislation moving forward in a continually divided Congress.

Led by moderator Matt Farber of the ACCC, Joseph Hill of the American Society of Health-System Pharmacists, Cara Tenenbaum of the Ovarian Cancer National Alliance, and myself, we discussed some of the most pressing current issues in health policy, starting with the sequester. Although there were varying degrees of optimism between the panelists on the elimination of the sequester as a whole, we all did agree that it is likely to cause long-term effects even if it is repealed relatively quickly.

The Effects of the Sequester

Although the sequester was originally designed to be a blunt budget-cutting tool so devastating that no one in Congress would actually allow it to happen, we now know that it did happen and the sequester is in full effect. Now, no one believes that the sequester will be eliminated before the end of the year, and that means there will be a significant impact on the oncology community. Besides the 2% across-the-board reduction to Medicare reimbursement, the panel also talked about the less-direct impacts to the provision of cancer care, such as reduced funding for research and clinical trials, and the difficulty in maintaining the drug approval process timeline in the face of dramatic cuts to the budgets of the National Institutes of Health and the US Food and Drug Administration.

Considering the current state of Congress, as well as what is expected over the next 2 years, the panel expressed concern over healthcare legislation moving independently. Instead, Mr Hill noted that legislation concerning drug shortages, such as track-and-trace or pedigree bills, may not be introduced or see any kind of movement until a larger, more broad-sweeping piece of healthcare legislation is introduced. With Congress in the mindset to only pass bills that are considered “must-pass”—bills that must pass to avoid a government shutdown—Mr Hill believes that a continuing resolution on the budget may be the best vehicle for some of the drug shortage legislation that may be introduced.

By contrast, I felt that there is still an opportunity to see bills move independently of larger vehicles, particularly bills that have no (or a very low) fiscal note and a large groundswell of bipartisan support, such as legislation to create parity between oral anticancer medications and their intravenous-infused counterparts. In this budget-conscious climate, bills that do not require additional federal funds will have the greatest likelihood for movement.

Fixing the Sustainable Growth Rate

Next, the panelists addressed the probability that the sustainable growth rate (SGR) formula would finally be permanently fixed in the 113th Congress. Each panelist agreed that it may be too early to tell, but if Congress seriously plans to address the issue, now is the time. The Congressional Budget Office (CBO) recently rescored the 10-year SGR fix at $138 billion. This is a relative “bargain,” down from $240 billion in previous CBO estimates.

It was discussed that the health subcommittees of the House Ways and Means and the House Energy and Commerce committees are floating ideas for legislation to fix the fundamentally flawed formula.

All of the panelists have heard rumblings that this may be the year that we actually see legislation introduced, but the particulars of such legislation—and how it will be paid for—are still unknown. However, each panelist did stress the importance of advocacy and the impact that the provider community could have on this issue. As committee members on both sides of the aisle float ideas on repeal, it will be vitally important that ACCC members let their members of Congress know how the flawed SGR formula impacts them and their ability to care for their patients.

Get Involved

The 39th Annual National Meeting was a great success thanks to the participation of ACCC’s members and supporters. Members are encouraged to get involved in grassroots advocacy to help shape the policies impacting cancer care. For more information and ways to get involved, please visit www.accc-cancer.org/advocacy.

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