ASBMT Opposes the Graham-Cassidy Proposal

The ASBMT opposes the Cassidy-Graham-Heller-Johnson Amendment to H.R. 1628, the “American Health Care Act of 2017” and insists it must not be supported by the Senate.  On behalf of the patients we treat, and our members themselves, we ask Senators to not support any version of the legislation that removes access to care or creates discriminatory pricing practices for those individuals and families affected by illness.  

Blood and marrow transplantation (BMT) 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.

Similar to proposals that were considered in the Senate in July, we believe the Graham-Cassidy Amendment would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.

Utilization of BMT by Americans is estimated to be approximately 139 transplants per 1,000,000 individuals. The loss of insurance by millions of individuals would mean that many people who otherwise may have received a hematopoietic cell transplant, will not have access to this curative therapy.

The costs of these illnesses will not disappear through modifications to the insurance provision system – individuals with acute hematologic malignancies who do not have access to affordable insurance will seek care in the emergency setting, likely resulting in high costs, for largely futile treatments, that will need to be absorbed elsewhere in the system.  For those individuals who seek care but are not allowed to proceed to transplantation due to benefit exclusions, their unnecessary early mortality will have severe emotional and economic impacts on their immediate family units.

The ASBMT will continue to OPPOSE any legislation that:

  • Allows discriminatory pricing based on age or pre-existing condition:  Blood cancers are physically devastating and are not predictable or avoidable based on personal health behaviors.  Individuals who have received BMT/HCT for treatment of their blood cancer, or for treatment of another debilitating chronic disease such as sickle cell disease, should not be additionally punished by facing on-going challenges in securing health insurance coverage or having to pay multiples of the standard premium.  Every individual who receives a BMT/HCT will subsequently be subject to these experience rating pricing increases when seeking insurance outside of a large employer setting.  High risk pools will not be sufficient for meeting the needs of the 25% of the total United States population that has at least 1 pre-existing condition. 
     
  • Reduces Medicaid funding:  Reduction of Medicaid funding through limited block grants or the application of per-patient capitation will result in individuals being unable to pursue treatments that are initially cost-intensive but result in reduced disease and cost burden over time.  Each year, approximately 1,600 pediatric patients receive BMT/HCT, many of which utilize Medicaid as a primary payer.  Removing or reducing funding will result in a direct decrease in our ability to provide necessary care for these children. In the adult population, eliminating States' abilities to expand eligibility for Medicaid benefits in conjunction with removing the individual market subsidies will create an on-going barrier to accessing care for lower-income individuals.
     
  • Results in large decreases in the current number of individuals with health insurance.  The current proposal removes federal funding for Medicaid expansion and individual subsidies, as well as removes employer and individual requirements.   Senate leadership is proposing to vote without waiting for a Congressional Budget Office score that would quantify the losses, though predictions of losses associated with previous and similar repeal attempts are over 30 million individuals. 

The ASBMT asks that all Senators vote against legislation that would jeopardize health insurance coverage for tens of millions of Americans.  We welcome questions regarding the impact of proposed health care legislation on the lives of the patients we serve.