Advocates push for cancer treatment

Friday, Feb. 27, 2009

Everyone deserves the right to cancer treatment after being diagnosed regardless of their socioeconomic status.

That's the stance that several Maryland legislators and advocates have taken and on Wednesday they convened in Annapolis to solicit support for a cancer treatment bill.

HB 181 and SB 487, titled the Maryland Cancer Treatment Program, would provide cancer treatment to qualifying uninsured Marylanders under the federal poverty level during the first year after being diagnosed. The program will reimburse providers at the rates established for the Maryland Medical Assistance Program.

As a three-time cancer survivor, Elaine Koogler said she knows the costs of cancer treatment and believes everyone should have the right to it. Koogler, of Prince Frederick, said she had to rely on the federal program, COBRA Insurance, which was signed into law in 1986, and ensured continuing health coverage at group rates after she was laid off five years ago. A third of her unemployment check went to cover her health insurance through COBRA, she said.

"I have to have insurance. If I let it lapse it might be problematic," she said, adding insurance providers normally do not cover pre-existing conditions. And, by law, a diagnosis of cancer can be considered a pre-existing condition up to 10 years, she said. Koogler, an avid cancer treatment advocate for years, testified before the Maryland Senate Finance Committee on Wednesday.

"They were very, very receptive," she said. Those testifying gave moving stories, Koogler said.

Some critics say the bill and supporters are paving the way to socialized medicine.

"No, we're not," she said. The bill supports access to cancer care for those who cannot afford it and do not have insurance, she said.

"America is one of the wealthiest nations … Yet, we rank way down in health care," Koogler said. Calvert County is one of the wealthiest counties, but some people diagnosed with cancer here do not have access to cancer treatment, she said. If people are able to receive treatment early it will actually save money for the health care system and all who pay health insurance, she said. It's the advanced stages of cancer treatment that are the costliest, she added.

Del. Shirley Nathan-Pulliam (D-Baltimore County), a nurse for nearly 50 years, originated the bill in the House. The bill, in its third year, remains in committee as of Thursday morning.

"I don't have cancer and no family members do," Nathan-Pulliam said. But, "to not have insurance with cancer is a death sentence, literally."

"With both bills, [Senate and House] she has been there testifying. Those are her babies," Koogler said of Nathan-Pulliam.

A second cancer treatment-related bill allowing mastectomy patients to stay in the hospital up to 48 hours after surgery passed through the second reader on the floor on Wednesday and it will come up one more time before the final vote, said Nathan-Pulliam's aid on Thursday morning.

The bill gives the decision to doctors, not an insurance company, Del. Sue Kullen (D-Calvert) said.

Koogler also testified on this bill two weeks ago and said that no insurance companies testified against it, even though some insurance companies have not allowed patients an overnight stay after a mastectomy.

"It's barbaric; 18� years later, I still remember the pain," she said of her mastectomy.

"It's not going to cost the state a thing."

A third bill in the legislature this session requires insurance companies to allow patients a mammogram every year when doctors recommend it. The bill is specific to CareFirst, which currently only pays for mammograms every two years, Kullen said. The bill is in its third read in the House as of Thursday. Another bill in committee requires insurance companies "to follow the American Cancer Society [ACS] guidelines" in breast cancer screenings, said Bonita Pennino, ACS director of government relations in Maryland. Both bills should be on the floor for vote today or next week, she said.

"I'm glad I'm on the health and government committee, it's a good committee to be on," Kullen said.

The Maryland Cancer Treatment Program is modeled after cancer treatment legislation passed in Delaware and initiated in July 2004. As part of the Delaware Health Care Commission, the Delaware Uninsured Resources oversees the state health cancer treatment program.

"It's one of the best programs we have in Delaware," a health program representative said. Once a person is diagnosed with cancer it's difficult to continue employment or get a job if they are not working, she said. The program meets the needs of these people, she added.

"It is so important for every Maryland resident to receive cancer treatment and screenings that are affordable. It's simple ... the program will save lives," said Kristin Batson, co-chair for Calvert County Relay for Life in an e-mail.

From 1999 to 2003, there were 24,777 cancer diagnoses reported in Maryland. From 2001 to 2005, there were 10,285 cancer deaths, according to statistics from the American Cancer Society. Cancer is the second leading cause of death in Maryland.

"We actually saw a decline in breast cancer deaths for the first year last year," Koogler said of national statistics.

One of the reasons is access to treatment, Koogler said, and she continues to ask people to write letters and make personal visits to legislators in Annapolis to lobby for the MCTP bill.

The bill, if voted into law, would take effect in July 2011 and has graduating degrees of income qualifications.

In the first year, the household income would need to be less than 116 percent of the federal poverty level, or FPL, which would be $12,064 per individual and $24,492 for a household of four.

The following year, the percentage would increase to 200 percent and then 300 percent in 2013, raising the qualifying income levels of an individual to $20,800 and up to $31,200 in 2013.

Kullen sponsored the bill and said people should be covered for cancer treatment, and in the larger picture, people who do not have coverage should be able to get health insurance.

"Our committee has worked long and hard on this bill. I support it, but it's going to be tough," she said.

It will be hard to get anything new through this year in light of the current economic situation, Kullen added.

Delegates are looking into the stimulus package for possible funding for the bill to "see if anything could be done on a temporary basis," she said last week. Stimulus funds will be helpful with Medicaid, which covers all health-related issues, she added.

Koogler too said she understands the difficulty in selling the program this session, but she asks legislators to work and try to figure out a way to pay for it.

"When bright people come together you can come up with solutions," she said. "We're thrilled Gov. [Martin] O'Malley did not cut breast and cervical cancer detection [programs] in Maryland," she added.

In January 2008, the Department of Legislative Services estimated that at 300 percent of the FPL, which is the 2013 percentage, the general fund expenditures could increase by $37.3 million in FY 2009. The income requirement is more liberal that the initial 2011 income requirement of 116 percent of the FPL, which would be approximately $12,000 for individuals and $24,500 for a family of four.

The average cost of cancer treatment in Maryland in 2007 was just below $20,000 per patient.

charvat@somdnews.com