After spending much of his 2014 re-election campaign running tv ads showing his support of breast cancer screening for uninsured women, Gov. John Kasich has completely eliminated Ohio's Breast & Cervical Cancer Treatment Program (BCCP Medicaid) from his FY 2016-2017 budget. The program provides emergency, temporary Medicaid coverage to uninsured women earning up to 200% of FPL who were diagnosed through the state's free screening program. His proposal doesn't just leave it out of the budget, it eliminates the program completely. Forever.
It seems that, while Kasich plans to fund free mammograms and pap tests for uninsured women up to 200% FPL, if they're diagnosed and not eligible for the Medicaid Expansion (which only covers those earning up to 139% FPL) they'll have to buy private health insurance. In short, he only cares if you get diagnosed, he doesn't care if you need treatment. And if you're lucky enough to earn so little to qualify for the Medicaid Expansion, he's going to charge you a monthly premium to get it.
While there are high hopes that the patchwork of programs in ACA will eventually cover most uninsured cancer patients, we're still a long, long way from having a real safety net when that cancer diagnosis blows up your world, your job, your family and your finances.
This story from last Friday shows how easy it is for breast cancer patients to lose their health insurance coverage:
City Of Dublin Forces Officer Battling Breast Cancer To Pay Insurance Premiums
Unlike many other cancers, breast and cervical cancer are ideally diagnosed before they reach Stage 4. But unlike many other cancers, uninsured women under age 65 with a Stage 1, 2 or 3 diagnosis aren't eligible for Social Security Disability or Medicare. In the post-ACA world, some of these women will be eligible for the new Medicaid Expansion. But its likely many won't be able to negotiate applications for private insurance, especially if they're diagnosed outside the ACA enrollment period.
As you all know, there's no good time to get breast or cervical cancer, but getting a diagnosis outside of the ACA enrollment period in a state that ranks as one of the worst in the nation for educating and enrolling it's uninsured citizens into Medicaid or ACA marketplace insurance plans, is difficult indeed. Many providers across Ohio remain uneducated about how to help their uninsured cancer patients. Most will simply refuse to allow the patient with a lump or suspicious mammogram to make an appointment. A 2014 survey showed 40% of Ohio doctors in the Ohio State Medical Assn. planned to see fewer Medicaid patients in the future. You can be sure when an uninsured cancer patient calls, they won't be answering the phone.
Let's also not forget that Ohio's federal exchange leaves it vulnerable to the upcoming SCOTUS decision. An adverse ruling will automatically throw thousands out of health care plans and make them unaffordable for those in a cancer crisis. And as for the future of the Medicaid Expansion in Ohio? After watching Kasich campaign on breast cancer issues, while planning to yank their treatment coverage, can he be trusted to protect it?
Predictably, lurking backstage for this fiasco is Komen's Ohio Affiliates. Never a supporter of the BCCP Medicaid program, they've always lobbied for funding of the free screening program. For all those uninsured women diagnosed through Ohio's still-funded free screening program, Komen plans to raise money to help them pay for their private insurance premiums and treatment co-pays, according to confidential sources. That's the same plan they had when they first lobbied against providing emergency Medicaid coverage in 2000. Some things never change. What do you call it when a charitable organization works to prevent access to affordable care for uninsured breast cancer patients, then raises money so they can "help" them? Münchausen syndrome by proxy?
So, as cancer survivors, patients or concerned others, its important to learn you're never completely assured of having access to affordable care for cancer. As other states follow Ohio's lead (Maryland and Arkansas already have), we'll have to stay vigilant and never take for granted access to affordable care.
Monday Night Cancer Club is a Daily Kos group focused on dealing with cancer, primarily for cancer survivors and caregivers, though clinicians, researchers, and others with a special interest are also welcome. Volunteer diarists post Monday evenings between 7:30-8:30 PM ET [generally speaking] on topics related to living with cancer, which is very broadly defined to include physical, spiritual, emotional and cognitive aspects. Mindful of the controversies endemic to cancer prevention and treatment, we ask that both diarists and commenters keep an open mind regarding strategies for surviving cancer, whether based in traditional, Eastern, Western, allopathic or other medical practices. This is a club no one wants to join, in truth, and compassion will help us make it through the challenge together.