Cancer care in California isn’t fair, but a new law could help

Low-income patients who need specialized cancer treatment often struggle to get it. Advocates say the new law is a small step toward improving services

SACRAMENTO, CA – This story was originally published by CalMatters.

Cancer is the second leading cause of death in California, after heart disease. This year alone, the state is estimated to see 189,000 new cancer cases and nearly 61,000 deaths.

Although patients often need specialists, treatment and the opportunity to participate in clinical trials, this access is not equitable across the state. It usually depends on where they live and sometimes their health insurance.

Cancer patients with lower incomes—and especially those in rural areas—tend to fare worse. Studies have shown that patients with Medi-Cal, the health insurance program for low-income residents, are less likely to receive recommended treatments and have lower cancer survival rates compared to people with private insurance.

That disparity is at the heart of a California law recently signed by Gov. Gavin Newsom that supporters say will make it at least a little easier for Medi-Cal patients to access cancer subspecialists, treatments and clinical trials.

The new law, which takes effect in January, requires Medi-Cal insurance plans to “make a good faith effort” to contract with National Cancer Institute-recognized cancer centers — which often have access to the latest treatments — or other qualified cancers . centers.

Authored by Democratic Sen. Anthony Portantino of Glendale, it was originally designed to mandate that Medi-Cal plans add at least one of these cancer centers to their provider networks, but negotiations resulted in a watered-down version that only required health plans to be tested. add a cancer center.

The law also requires Medi-Cal plans to inform enrollees with complex cancer of their right to request a referral to any of these centers, even if it is outside their plan’s network. However, whether a patient can be treated at one of these centers depends on whether the plan and the out-of-network provider can agree on payment. This recommendation is crucial, supporters say: Patients can’t ask for something they don’t know is an option.

Advocates say the bill, while limited, will be an important step in helping low-income cancer patients get specialized care.

“I think making incremental changes has the ability to save lives, and that’s what we’re trying to do here,” Portantino said.

Too often, patients from underserved communities come to these specialized cancer centers very late after diagnosis, said Dr. Joseph Alvarnas, a hematologist-oncologist and vice president of government affairs at City of Hope, one of eight California cancer centers with the National Cancer Institute. label and bill sponsor.

“The conversation starts with ‘I wish I could have gotten here sooner’ or ‘My family and I fought to get here,'” he said.

Alvarnas said that historically the City of Hope saw more Medi-Cal patients, but that has changed since the state largely moved its Medi-Cal program away from a fee-for-service model (in which patients could see any provider that accepted Medi-Cal ). -Cal and the state paid providers for each service provided) to managed care (considered a more cost-effective model where the state pays health insurance companies a fixed amount per enrollee).

“In managed care, part of the way that model works is that it involves tighter networks of doctors and a more limited choice of hospitals,” Alvarnas said. “If you have high blood pressure or a condition that many types of doctors can take care of, that’s fine.

“But when it comes to cancer care, your network of clinicians may not have an expert in leukemia or relapsed myeloma.

Hospitals sometimes have to send some of their sickest patients to cancer centers like City of Hope — as was the case for Patrick Nandy of Whittier. In 2008, during his senior year of college, he was diagnosed with acute lymphoblastic leukemia, a cancer of the blood and bone marrow that can progress very quickly. Nandy said that when the oncologists at St. Jude Medical Center could no longer treat him, he was transferred to City of Hope, where he participated in a clinical trial of chemotherapy and cord blood stem cell transplantation.

“I think about how lucky I am,” Nandy said. “The doctors said two more weeks and I would probably be gone.

These are the types of therapies that should be available to all patients with complex or aggressive cancers, but that’s not always the case, Alvarnas said.

A 2015 analysis by the University of California, Davis found worse outcomes for cancer patients with Medi-Cal compared to people with other types of insurance. Among some of the findings: 39% of breast cancer patients using Medi-Cal were diagnosed at an early stage, compared with 61% of patients who were privately insured.

The study also found that Medi-Cal patients diagnosed with early-stage lung cancer had a 48% five-year survival rate, less than the 65% five-year survival rate for those with private insurance. Medi-Cal patients were also less likely to receive needed therapies or treatments for several types of cancer.

The law will apply to people with rare or complex cancers, including advanced brain cancer, lung cancer, colorectal cancer, leukemia and lymphoma, among others, Alvarnas said. Popular treatment and research centers include City of Hope, University of California Comprehensive Cancer Center, Stanford Cancer Institute, as well as numerous Kaiser Permanente sites and Cedars Sinai’s Cancer Institute.

While the bill, as passed, had no registered opposition, it was weakened during negotiations with providers, health plans and the California Department of Health Services, which oversees the Medi-Cal program.

Health insurance plans initially opposed Portantino’s bill because the requirement to contract with the centers, they warned, comes with new administrative hurdles that could disrupt or delay patient care.

Linda Nguyen, an attorney with the Western Center for Law and Poverty, said her organization withdrew its support after the law was narrowed. “It actually requires plans (to contract with cancer centers) — that would bring some meat to the table,” Nguy said. “Our understanding is that plans are already trying to contract with as many providers as possible, but there is a reimbursement issue.”

Medi-Cal, which covers about a third of Californians, pays providers a lower rate than other types of insurance. While lower reimbursement rates make the program more cost-effective, low payments may discourage providers from participating in Medi-Cal.

The debate about equity in cancer care shows the complexity of achieving real access even in a state that has expanded insurance coverage to more people. California is set to become the first state in the nation to offer Medi-Cal coverage to all earners regardless of immigration status. Last week, Gov. Gavin Newsom’s office announced that 286,000 undocumented people age 50 and older began receiving comprehensive coverage in May. In 2024, California will open Medi-Cal to about 700,000 more people ages 26 to 49.

“The state has worked very hard over the last decade to improve health care coverage,” Alvarnas said. “But the problem is that there is a gap between coverage and actual access because the state is also focused on making sure that health care costs are somewhat controlled.”

While the bill fell short of what its proponents originally sought, work to make cancer care more accessible will continue, said Autumn Ogden-Smith, director of state legislation for the American Cancer Society Cancer Action Network, another sponsor of the bill. For example, making it easier to get a patient to one of these cancer centers if they don’t live nearby is a priority, she said.

“When you pull up a map, you’ll see that these centers typically cover certain areas: San Diego, Los Angeles, San Francisco, Davis-Sacramento,” Ogden-Smith said. “We’re going to have to focus on getting people in Northern California and the middle of the state” to cancer centers.

CALmatters.org is a non-profit, nonpartisan media enterprise explaining California politics and policy

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