Dixon Matthew S, Cole Ashley L, Dusetzina Stacie B
UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Cancer J. 2017 May/Jun;23(3):175-180. doi: 10.1097/PPO.0000000000000262.
The Patient Protection and Affordable Care Act (ACA) included several key provisions aimed at lowering the out-of-pocket cost burden for patients. In this review, we summarize the effect of 3 provisions under Medicaid, Medicare, and commercial insurance, respectively: expansion of Medicaid eligibility, closing the doughnut hole for Medicare Part D beneficiaries, and requiring an annual limit on out-of-pocket spending for commercially insured patients. Through this review, we find early evidence that these 3 ACA provisions have reduced the out-of-pocket burden or increased access to health insurance for many patients. Proposals to repeal and replace the ACA should consider retaining some of these important features that limit financial exposure for patients. At the same time, we have highlighted some important gaps left by the ACA that could be targeted by replacement plans. Addressing these issues may help to increase access to care and affordability for patients with cancer and without.
《患者保护与平价医疗法案》（ACA）包含了几项旨在减轻患者自付费用负担的关键条款。在本综述中，我们分别总结了医疗补助、医疗保险和商业保险下三项条款的效果：扩大医疗补助资格范围、填补医疗保险D部分受益人的“甜甜圈洞” 以及对商业保险患者的自付费用设定年度限额。通过本综述，我们发现早期证据表明，ACA的这三项条款减轻了许多患者的自付负担或增加了他们获得医疗保险的机会。废除和取代ACA的提议应考虑保留一些限制患者财务风险的重要特征。同时，我们也强调了ACA留下的一些重要空白，替代计划可以针对这些空白。解决这些问题可能有助于提高癌症患者和非癌症患者获得医疗服务的机会并降低费用负担。
