Chapter 22: The Future Under the Affordable Care Act: the Value of Prevention Services
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Description
In this segment, Dr. Foxhall sketches what the future looks like under the Affordable Care Act, noting that a change in leadership in Texas might change any predictive scenario and the state will continue to have poor and undocumented individuals to cover.
Dr. Foxhall explains that the focus on preventive services is a very positive feature of the ACA. He explains the requirements and notes the benefits that can come from screening services and tobacco cessation programs. He cites statistics for the increase cancer risk that comes with smoking and obesity. He explains why institutions tend not to invest in prevention, noting that the ACA is unusual in adding this to its requirements.
In conclusion, Dr. Foxhall notes that the ACA is “still a political football” and that politics has an impact on each decision connected with it.
Identifier
FoxhallLE_05_201405013_C22
Publication Date
5-13-2014
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - The Finances and Business of MD Anderson; MD Anderson and Government; The Healthcare Industry; Politics and Cancer/Science/Care; The Institution and Finances; Growth and/or Change; MD Anderson History; On Texas and Texans
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
I see. Okay. Interesting. What’s the long-term prognosis for dealing with this issue, the challenges of the uninsured and wrestling with the provisions of the Affordable Care Act? What are some of the big points?
Lewis Foxhall, MD:
Well, the Act is law and it’s being implemented and it’s potentially going to be able to enroll more people down the road, so I think for those that are in the income categories that are open to participation we’ll see that continue to increase. The penalties go up year after year, so it’ll be more of an incentive for individuals to participate. It’s not clear what businesses will do, if they’ll just accept the penalties or if they will go ahead and provide care. But regardless, with that individual being required to have coverage or get taxed extra, then this kind of shoves a lot of people into the participation categories. So I think that’ll continue to increase. So it won’t take care of everybody. We still have our issues with low-income groups, and time will tell what the state decides to do. It all has to do with state leadership in this election cycle, so they may have a slightly different approach to how that will be managed in relationship to the federal government. So that’s kind of in the TBD department. (laughter)
Tacey Ann Rosolowski, PhD:
Yes, yes.
Lewis Foxhall, MD:
But there will still be poor people in Texas. We will still have people who are here who are unauthorized immigrants [unclear]. We want to take care of them the best we can.
Tacey Ann Rosolowski, PhD:
Is the number of undocumented individuals growing?
Lewis Foxhall, MD:
It declined, actually, or at least stabilized during the economic recession, but it’s, I think, starting to creep back up again. So a lot of it is an economic pressure to encourage people to take the risk of [unclear].
Tacey Ann Rosolowski, PhD:
Is there anything else that you’d like to add about this [unclear] problem? (laughs)
Lewis Foxhall, MD:
Yeah. Well, yeah, it’s just a work in progress. The other positive thing, I think, is the coverage for preventive services, which is part of the Act. So the requirements that each plan offered have some sort of benefits related to prevention. of which several are related to cancer risk, so that’s a good thing. So there’s no out-of-pocket cost for people who have coverage to get those sorts of either screenings or access treatment for tobacco use or obesity counseling, sorts of things. So that’s a positive aspect. Over time that will help.
Tacey Ann Rosolowski, PhD:
How long do you think—I mean, those are kind of behavioral and sometimes addiction issues that can be very resistant. How long do you think it will take before those sort of supports for patients will register?
Lewis Foxhall, MD:
Well, screening is immediate if people do it. I mean, that helps identify people that have early disease and get them treated where we can actually have a lot better outcome. So that’s a fairly immediate sort of thing. Getting somebody who’s a smoker to quit has some positive immediate benefits, but it just increases over time, and with treatment, at least 30 to 50 percent of smokers can stop. So our program here at Anderson has about a 50 percent success rate.
Tacey Ann Rosolowski, PhD:
Oh, really?
Lewis Foxhall, MD:
Overall, I think it’s about 30, so people that partake of that help. Dealing with obesity is more challenging, but there are some success formulations there as well. So all that helps, and those kind of big risk factors take their toll over time, so while there is some positive immediate benefit, it’s primarily related to cardiovascular disease risk reduction, and cancer risk is more a longer-term thing. But if we can do some things like not have this next generation of kids smoke than the previous generations have, then that starts the clock ticking, and over time we’ll see some very significant benefits.
Tacey Ann Rosolowski, PhD:
I read somewhere, too, that obesity levels are dropping among children in certain ethnic groups, which is good news.
Lewis Foxhall, MD:
Slightly, yeah, so it’s a little bit. Well, they’re not increasing. (laughter)
Tacey Ann Rosolowski, PhD:
I guess you read a less optimistic report than I did.
Lewis Foxhall, MD:
Well, a little bit better, but anyway. And it’s not exactly clear why that’s going on, but it’s relatively good news at least for that population. But we still have a third of the population that’s in the significant obese categories, so they’re at increased risk. So that’s a 15, 20 percent increase cancer risk, and then, of course, tobacco accounts for probably 30 percent of all cancers. Lung cancer kills more people than the next four cancers combined. It’s still a huge problem for us. Of course, a lot of that’s just the legacy of tobacco use that has occurred over decades, so we’ll try to work our way through that. But meanwhile, we’re looking at potentially screening for lung cancer with CAT scans and things of that sort that may help a little bit. But the main thing is to quite exposing people to burning tobacco leaves.
Tacey Ann Rosolowski, PhD:
Why do you think that institutions have been relatively slow or haven’t thrown themselves into prevention as thoroughly as they have thrown themselves into discovering drugs, for example? What’s the value system that’s kind of creating that balance?
Lewis Foxhall, MD:
Well, in research, research funding for prevention is significantly less than research funding for other things. That’s a big part of it. In the treatment world, up until just recently, a lot of prevention services were not covered by insurance, and it’s costly for people to do that. You make a lot more money taking care of people who are sick than keeping them from getting sick. So there’s some financial disincentives to all that going on. So it’s just sort of the way things are set up.
Tacey Ann Rosolowski, PhD:
Is the Affordable Care Act unusual in the way it has stressed prevention to the degree that it has?
Lewis Foxhall, MD:
Well, it’s a change. There are some insurance policies previously that covered those sorts of things, but they’ve generally been more expensive policies that were really available to higher-income individuals. So the change here is that this is something that even low-income people can access.
Tacey Ann Rosolowski, PhD:
Is there anything else you’d like to say about this situation?
Lewis Foxhall, MD:
Well, I think it’s just a work in progress here, and, you know, the difficult part is still a political football, and the challenges that we face with trying to implement it are impacted by political considerations, and that’s just the nature of the beast. But hopefully we can focus on the potential benefits for people who might avoid getting cancer and for people who have or have had cancer. So there are some significant pluses in the legislation for the population that we’re concerned about, but it’s going to getting pushed back and forth for years to come, I’m sure.
Tacey Ann Rosolowski, PhD:
Well, if there’s nothing else you’d like to add, Dr. Foxhall, I thank you very much for your time this morning.
Lewis Foxhall, MD:
You’re quite welcome.
Tacey Ann Rosolowski, PhD:
This has been really, really helpful, and I’m glad we took the time to kind of flesh out this dimension.
Lewis Foxhall, MD:
Yeah, that’s a good piece of what’s going on.
Tacey Ann Rosolowski, PhD:
It is indeed. It is indeed. Well, thank you very much.
Lewis Foxhall, MD:
Okay. Thanks.
Tacey Ann Rosolowski, PhD:
And I am turning off the recorder at about two minutes after ten. And I don’t think I mentioned earlier that I turned on the recorder at precisely 9:30. Okay. (end of session five)
Recommended Citation
Foxhall, Lewis E. MD and Rosolowski, Tacey A. PhD, "Chapter 22: The Future Under the Affordable Care Act: the Value of Prevention Services" (2014). Interview Chapters. 871.
https://openworks.mdanderson.org/mchv_interviewchapters/871
Conditions Governing Access
Open
