WASHINGTON — Some of America’s best cancer hospitals are off-limits to many of the people now signing up for coverage under the nation’s new health care program.
Doctors and administrators say they’re concerned. So are some state insurance regulators.
An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington’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.
In all, only four of 19 nationally recognized comprehensive cancer centers that responded to The Associated Press’ survey said patients have access through all the insurance companies in their states’ exchanges.
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 if top-level institutions are included in a plan. “The challenges of this are going to become evident … as cancer cases start to arrive,” said Norman Hubbard, executive vice president of Seattle Cancer Care Alliance.
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 trap-door for cancer patients, are also banned.
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.
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.
AP asked the centers how many insurance companies in their state’s exchange included them as a network provider.
Of the 19 that responded, four reported access through all insurers: the Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, Fox Chase Cancer Center in Philadelphia, Duke Cancer Institute in Durham, N.C., and Vanderbilt-Ingram Cancer Center in Nashville. One caveat: Some insurers did not include these cancer centers on certain low-cost plans.
In Buffalo, N.Y., Roswell Park Cancer Institute is included by five of seven insurers in its region.
But statewide, the picture is much different: Roswell Park is not included by 11 of 16 insurers. Dr. Willie Underwood, associate professor of surgical oncology at the teaching hospital, says that’s a problem.
“Overall, when you look at the Affordable Care Act, it improves access to cancer care,” said Underwood. “When it comes down to the exchanges, there are some concerns that we have. That is not being critical, that is being intelligent. There are some things we should talk about ... before they start becoming a problem.”
Access to cancer centers under health law
Some of the nation’s top cancer care centers are concerned about access for patients who purchase policies through the new health insurance markets, also called exchanges. The Associated Press asked 23 institutions that are part of the National Comprehensive Cancer Network whether they were included in the networks of insurance companies operating on their state’s exchange. Here are the responses they provided:
• Fred & Pamela Buffett Cancer Center, Omaha, Neb.
In-network with three of four exchange insurers, but one of them includes Buffett only on some plans. A fourth insurer does not include Buffett.
• City of Hope, Los Angeles.
In-network for one of three major insurers; a fourth is a health maintenance organization with its own hospital system.
• Dana-Farber, Boston.
• Duke Cancer Institute, Durham, N.C.
In-network with the two insurers on the exchange, although not included in a low-price option.
• Fox Chase Cancer Center, Philadelphia.
In-network for the two dominant carriers in the market.
• Huntsman Cancer Institute, Salt Lake City.
In-network with five of six insurers.
• Hutchinson/Seattle Cancer Care Alliance, Seattle.
In-network with three of eight insurers on the state’s exchange.
• Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore.
In-network for all six exchange insurers, although some individual plans may not offer access.
• Memorial Sloan-Kettering, New York.
In-network with two of nine exchange insurers in New York City, two of 16 statewide. Has out-of-network agreements with two more carriers.
• Moffit Cancer Center, Tampa, Fla.
In-network for three of six insurers offering plans in multiple Florida counties.
• Ohio State University/James/Solove.
• Roswell Park Cancer Institute, Buffalo, N.Y.
In-network with five of seven insurers in its local area, but only five of 16 statewide.
• Siteman Cancer Center/Barnes-Jewish, St. Louis.
In-network for some of the plans offered by one of two insurers on the state exchange.
• St. Jude Children’s Research Hospital, Memphis, Tenn.
Treatment is free as long as children have a referral.
• Stanford Cancer Institute, Stanford, Calif.
• University of Alabama at Birmingham, Birmingham, Ala.
In-network with dominant carrier of two insurers on exchange.
• UC San Diego Moores Cancer Center, La Jolla, Calif.
In-network with one insurer, by design.
• UCSF Helen Diller Comprehensive Cancer Center, San Francisco.
In-network for two of nine insurers in the northern California market.
• University of Colorado Cancer Center, Aurora, Colo.
In-network for all plans with six of 10 carriers; included on some plans by three others.
• University of Michigan Comprehensive Cancer Center, Ann Arbor, Mich.
In-network for eight of 12 insurers, although not in every plan.
• MD Anderson Cancer Center, Houston
In-network for two of 11 insurers in the state’s exchange, and 43 percent of individual plans in Houston area.
• Vanderbilt-Ingram Cancer Center, Nashville.
All four insurers have Vanderbilt, but one company does not include it in its least expensive plan.The Associated Press