WASHINGTON -- Some of the best U.S. cancer hospitals are off-limits to many 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 of eight insurers in Washington's insurance exchange. MD Anderson Cancer Center says it's in less than half of Houston area plans. 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 AP's survey said patients have access through all the insurance firms in their states' exchanges.
Not too long ago insurance firms would have been vying to offer access to renowned cancer centers, said Dan Mendelson, CEO of the Avalere Health market research firm. 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," he 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 whether top-level institutions are included in a plan. That takes more digging by people applying.
Before President Barack Obama's health care law, a cancer diagnosis could make you uninsurable. Now, insurers can't turn away those with health problems or charge them more. Lifetime dollar limits on policies, once a financial trap-door for cancer patients, are also banned.
The new obstacles are more subtle: 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, sending an implicit message to cancer survivors or any with a strong family history of disease that they should look elsewhere.
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 more institutions that joined this week were not included in the survey.
Cancer network members are leading hospitals that combine the latest clinical research with a multidisciplinary approach to patient care. They say their patients have better-than-average survival rates. The cancer centers' unique role is recognized under Medicare. Several are exempt from its hospital payment system, created to control costs.
The AP asked the centers how many insurance firms in their state's exchange included them as a network provider. Of 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.
Two centers had special circumstances. The best known is St. Jude's Children's Research Hospital in Memphis. Treatment there is free as long as children have a referral.
For the remaining 13, gaps were evident.
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.
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," Dr. Underwood said. "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."
The Obama administration says it has told insurers that their networks will get closer scrutiny next year in the 36 states the federal exchange serves. It said cancer care will be a priority.