Hot Topics in Community Cancer Centers: The Affordable Care Act

Sydney Abbott, JD
Policy Coordinator, Association of Community Cancer Centers

Every summer and fall, the Association of Community Cancer Centers (ACCC) hosts a series of Regional Oncology Economic and Man - agement Meetings. These meetings are targeted for members who are in the business of delivering cancer care in the hospital or the office setting. The regional gatherings offer ACCC members the opportunity to get together with other providers in their region to receive up-to-date information on the latest trends and the economics of oncology care. The ACCC has just completed its third regional meeting in Berkeley, CA.

The recent regional meetings have highlighted tips and trends on quality reporting and the transition to the International Classification of Diseases, Tenth Edition (ICD-10), updates from the new Commission on Cancer standards, financial counseling, payer negotiation in the age of accountable care organizations, patient navigation education, and a legislative update discussing the impact of policy measures on cancer care policy.

The hot topic at the most recent ACCC meetings has been the Patient Protection and Affordable Care Act (ACA) and how the US Supreme Court would rule on the constitutionality of the mandate within the ACA. After much anticipation, the Supreme Court recently upheld the law (with one exception regarding Medicaid expansion).

As expected, the decision on the constitutionality of the individual mandate in the ACA came down to a vote of 5 to 4, with Chief Justice John Roberts providing the swing vote for the majority. This is a bit surprising. Most people (including myself) believed that Justice Kennedy would be the swing vote.

The decision: The ACA, including the individual mandate that virtually all Americans buy health insurance, is constitutional (with the exception of one provision).

An Interesting Conundrum

What is interesting in this decision is the grounds on which the justices determined the law to stand. As you may remember, the primary argument for the upholding of the individual mandate rested in Congress’s power to regulate commerce between the states to require everyone to buy health insurance (ie, the Commerce Clause). There were not 5 votes to uphold the mandate on this ground. However, 5 justices (Roberts, Breyer, Sotomayor, Ginsburg, and Kagan) did agree that the penalty a citizen must pay if he or she refuses to buy insurance is a kind of tax that Congress can impose using its taxing power.

What this means: Congress does not have the power to tell you to buy health insurance, but it does hold the power to tax you if you do not.

Because the mandate survives, the Supreme Court did not need to decide what other parts of the statute were constitutional, except for a provision in the ACA requiring states to comply with new eligibility requirements for Medicaid or risk losing all of their Medicaid funding. On that question, the Court held that the provision is not constitutional. States will have a choice whether to expand their Medicaid programs; those that do not comply with this new requirement will lose additional expanding Medicaid funding moving forward, but they will retain the federal funding they currently receive for their Medicaid program.

Assessing the Full Impact of the Decision

ACCC members can look forward to hearing a full breakdown of the Supreme Court’s decision on the ACA and the impact of the decision on community cancer care, as well as how Congress will address unresolved issues from the 2012 session— including next steps on a permanent solution for the sustainable growth rate—at the ACCC 29th Annual National Oncology Conference on October 3-6, 2012, in San Antonio, TX.

In addition, to help members better manage services, maximize re - sources, engage staff, and promote transformational change, they will learn pioneering strategies and practical tools from some of the top achievers in community cancer care—the winners of the 2012 Innovator Award.

More information about this meeting and others is available at As always, the ACCC will keep members up to date on the most current topics in cancer care.

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