Does Obamacare Deny Cancer Care for Seniors Over Age 75?

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One of the urban legends surrounding the adoption and early implementation of the Patient Protection and Affordable Care Act—called the ACA or Obamacare—was that the new law would deny care for cancer for seniors aged 75 years or greater.

Despite the media hype and partisan mudslinging, the concern was not (and still is not) true. The Affordable Care Act does not ration or refuse cancer care for anyone, regardless of age.

The Politics of the Affordable Care Act

When leaders in Congress first began work on the legislation that eventually became the ACA, several competing versions of the legislation, developed by shifting alliances of legislators from both parties, entered the Congressional Record. In 2010, the ACA—originally a bill from the House of Representatives labeled HR 3590—passed the Senate by a majority-only process called "reconciliation" without any support from congressional Republicans. It was signed by President Barack Obama on March 23, 2010.

The ACA is a large and complex law. It expanded Medicaid eligibility if the states elected it; it set new minimum requirements for health insurance coverage; it required that all Americans buy coverage or pay a fine; it required employers of a certain size to offer coverage to certain employees; and it set aside a pool of money to pay insurance companies that had "sicker" enrollees than others. On top of that, the ACA expanded the scope of the U.S. Department of Health and Human Services and increased the level of federal oversight into state insurance markets.

With so much going on, it's no surprise that some parts of the law proved popular and some parts proved unpopular. However, when the law came close to passage and the partisan interest in it began to increase, a very hard line between Democrats who championed the law and Republicans who opposed it spilled into the media and into average Americans' living rooms.

Fact Checking the Urban Legend

A rumor about senior care rationing arose from a competing bill in the House of Representatives, HR 3200. Stories sprung up about "death panels" and negative comparisons with Britan's National Health Service (which does manage care for the terminally ill to some degree) blossomed on the internet and on talk radio. 

The misinformation—delivered by poorly informed television pundits and fundraisers sending alarmist emails to either "fight" or "support" Obamacare by means of a political contribution—proved so pervasive that several different fact-check authorities weighed in such as Snope, Politifact, FactCheck, and Forbes.

Although some of the misinformation originated with right-leaning media influencers, the sheer complexity of the law combined with similar misdirection by left-leaning supporters of the law, left many Americans confused about what Obamacare would mean for them. It didn't help when one of the defining moments of the debate over the law came as Rep. Nancy Pelosi (D-CA), who was Speaker of the House at the time, was quoted endlessly on cable TV news shows saying that "we need to pass this law in order to know what's in it." Her quote was taken out of context, but the damage was done.

What Obamacare Covers for People with Cancer

Under the ACA, senior citizens electing Medicare coverage receive exactly the same benefits they received before the law was signed. Because the ACA focused on commercial insurance coverage for working adults, Medicare was largely untouched.

For Americans with cancer who were not yet eligible for Medicare, the ACA may have meant that they had access to health insurance whereas before they didn't—either through the Medicaid expansion or through paid or subsidized ​commercial coverage offered through one a state or federal insurance exchange. But beyond this improved access to health insurance coverage, the law itself was silent about both new and reduced benefits for cancer treatment.

In other words: The law didn't change anything about cancer treatments for anyone, although some Americans who previously lacked insurance coverage were now eligible for it thanks to the Medicaid expansion and the insurance exchanges.

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