People find me. I don't always know how they do it, but they find me. And they persist until they catch me between classes or other commitments and fire their ACA-related questions at me. For my part, I look for what the questions tell me about the zeitgeist here in Kansas City and beyond. What is it about the ACA that confuses my fellow citizens? What is it about the ACA that scares them? What are the biggest urban legends about the ACA?
In the past few days, I have been asked several times about the ACA's ban on cancer treatment for Medicare patients. You mean you haven't heard of it? Could that be because it does not exist in the ACA?
The first time I was asked about this, I wondered if it might be the product of lingering anxiety over the proposed-but-dropped Medicare benefit to fund a beneficary's doctor-patient conversation about end-of-life planning. Sometimes, anxieties can have a long fuse. And "death panels" certainly did get a fair amount of airplay.
But the second and third time I was asked about this made it clear that this concern is something different. There is evidence circulating that, since April 1, 2013, the sequester's cut to Medicare has had an unforseen effect on doctor-administered chemotherapy treatments under Medicare Part B. The across-the-board two percent cut, when applied to certain kinds of cancer treatments, cuts so deeply into the physician chemotherapy drug acquistion price plus 6% overhead payment that some have determined to turn patients away. Press reports indicate that oncologists refusing treatment on these grounds are urging patients to contact federal elected officials to complain.
This may explain the "connection" to the ACA. I have noticed, among the public, an increasing propensity to attribute every hiccup in health care markets and health care finance to the ACA. In this case, they are attributing every defect in our governing process to the ACA. That's why I'm thinking of putting together an essay on the ten biggest myths surrounding the ACA. (Please post your derby entries in the comments.)
That said, how do I respond now? I could explain that the ACA is very modest health care reform, quite incrementalist really and that it does not place extraordinary amounts of power in the Executive Branch to determine the scope of Medicare benefits. The Independent Payment Advisory Board, for example, is specifically precluded from addressing rationing. The "R" word is anathema to the drafters of the ACA.
I could also explain that some oncologists are in a better position to serve their patients at a loss for the sequestration period. It is not as if all Medicare chemotherapy patients are being turned away at the door by oncologists. This is further evidence — as if any more were needed — of how geography and income status are destiny in health care.
Finally, I could also explain that there are bills pending (including H.R. 1416) to terminate the application of sequestration to payment for certain physician-adminisered drugs under Part B of Medicare.
But I am not certain that truth is the antidote to an urban legend.