Yesterday, Senate Majority Leader McConnel officially released draft proposals from Republican Senators intended to modify the American Health Care Act legislation developed by the House of Representatives in March 2017.
As with the previous version of the legislation, the American Society for Blood and Marrow Transplantation cannot support the legislative provisions proposed by the Republican Senators due to their likely severely negative impact on access to care.
Blood and marrow transplantation is a complex medical procedure provided with a curative intent to individuals with hematologic malignancies and other life-threatening illnesses. Due to the resource-intensive nature of the transplant process, which includes an extensive recovery period, continuous health care coverage is critical to ensure optimal outcomes.
The Senate proposal does not substantially reduce the number of individuals that would lose insurance access if the AHCA is implemented. The removal of subsidies, the elimination of Medicaid expansion – even on an extended timeframe, placing a cap on Medicaid funding and the removal of the requirements for individuals to have insurance will lower the number of individuals with health insurance in the United States.
While we agree with the Senators authoring these proposals that individuals with pre-existing conditions should not face additional penalties when seeking coverage, the allowance for states to waive or modify the essential health benefit categories created by the Affordable Care Act will create a situation in which insurance offerings with more than basic catastrophic coverage will be priced at a level that renders them unavailable to many individuals who need them.
Utilization of BMT by Americans is estimated to be approximately 139 transplants per 1,000,000 individuals. Losses of insurance by those individuals who were able to gain coverage through Medicaid expansion and subsidies on the individual market will mean that these individuals are not able to seek and receive the care they need.
As we stated in a previous letter, while there are aspects of the previously enacted Affordable Care Act that remain problematic, repealing and replacing this legislation with an alternative that will deny access to curative therapies for millions of Americans is not a defensible solution. Aside from the devastating human consequences to affected patients and their families, a decrease in insurance availability will not reduce health care costs to the American public. Newly uninsured individuals will still be diagnosed with cancers and seek care, though at later stages where they are unlikely to be candidates for transplantation and other curative therapies. This will result in the provision of noncurative therapies that will nonetheless be costly, and the distribution of the financial burden of this futile care to individuals who remain insured.
On behalf of our patients and their families, the leadership of the ASBMT has a responsibility to evaluate proposed changes to federal health care legislation for their predicted impact on our ability to provide care. Given the expected dramatic decrease in access to health insurance and the resulting loss in access to lifesaving blood and marrow transplantation, ASBMT cannot endorse the American Health Care Act, or the proposed modifications offered by the Senate, as currently written. We strongly encourage our members to express their individual concerns to their representative Members of Congress. Finally, the ASBMT welcomes the opportunity to share more detailed concerns and the perspectives of our members and patients with legislators.
Krishna Komanduri, MD
President, American Society for Blood and Marrow Transplantation
To read a PDF version of this letter, click here.