All About Healthcare Reform: An Oncologist Turned Politician's View

Jason Westin, MD, is not an ordinary oncologist. While he treats patients with lymphoma at MD Anderson Cancer Center and designs clinical trials, he is also running as a Democrat for a seat in the 7^th Congressional district in Texas.

Dr Westin states that healthcare reform—particularly the bills that are currently under consideration in Washington, DC—is a large part of why he chose to take an unconventional career path.

“Healthcare reform definitely plays a role in why I’m running for Congress. I take care of people every day at work that are afflicted with cancer,” Dr Westin said in an interview with The American Journal of Pharmacy Benefits. “The discussion about reforming the healthcare system is something important to me. It has a lot of relevance for the people I take care of.”

Currently, GOP Senators are nearing a vote on the Better Care Reconciliation Act (BCRA). Much like the American Health Care Act (AHCA) that was passed by the House, the bill would make cuts to Medicaid, subsidies, and repeal several key provisions of the Affordable Care Act (ACA). The Congressional Budget Office reported that 22 million Americans would lose insurance under the bill, but it would decrease federal debt by $321 billion over the next 10 years.

Many Republican Senators have expressed concerns with the current bill, especially a provision that does not protect patients with preexisting conditions from high premiums. This mandate would particularly affect patients with cancer.

“With my practice, taking care of patients with cancer, every one of them has a preexisting condition that could potentially be hurt by the reforms coming through the healthcare bills coming through Congress right now,” Dr Westin said.

While Dr Westin acknowledges that the ACA has its own issues, he believes that current legislation does not aim to address the gaps. Instead, it seeks to wholly reform the healthcare system, which has proven difficult for legislators to accomplish.

Dr Westin told AJPB about a young patient with cancer he treated who responded well to a new medication, but lost insurance coverage and had to stop treatment. Even under the ACA, many patients lost coverage due to affordability or other factors.

He worries that without significant revisions to the BCRA to improve coverage, patients may not be able to receive necessary medical treatments, especially those with preexisting conditions or older patients who could face higher premiums under the legislation.

“Examples about preexisting conditions can really hit home, because any one of us can have a problem tomorrow that turns into a lifelong preexisting condition,” Dr Westin said. “Unfortunately, this story I tell about my patient being harmed by this is not unique or different. This is a fairly common scenario.”

For physicians, the BCRA may mean that patients with chronic diseases do not have access to ongoing care, which may result in an uptick in emergency department visits.

To craft more popular healthcare legislation, patients must be involved in decision-making along with other healthcare stakeholders, according to Dr Westin.

“Patients are a key group that needs to be at the table when these things are being discussed. Patients understand the issues that impact them—that is their life, that is their reality, that is what they deal with every day,” he told AJPB. “Patients need to have a voice in that process, but I don’t know that patients understand the full scope of how complicated healthcare delivery is. They can’t be the only people dictating what needs to happen in a bill.”

Another issue Senators are facing in passing the BCRA is the hyperpartisan nature of Congress. Since Democrats were not involved with crafting the legislation, Majority Leader Mitch McConnell (R-KY) must gain nearly all Republican votes to pass the BCRA.

Bringing a fresh perspective may prove to be beneficial to healthcare reform efforts. Since many legislators have been involved with politics their entire career, they may be unlikely to compromise on something brought to the table by another party. Physicians, on the other hand, have to look at the facts and go forward, even if it was not the path they initially expected, according to Dr Westin.

“Doctors have to act. They have to come up with a plan and find a way to come up with the best possible solution and move forward. If the facts lead them in a way they thought was not the way they thought it would go in the beginning, they can’t debate that and not act. The patient is waiting for a treatment,” Dr Westin said. “That’s something that would serve well to have more people who are not career politicians—who are not so ingrained in 1 position that they can’t see the merit in points from a different perspective.”

Input from various healthcare stakeholders and patients could have the potential to transform healthcare, as these groups may have concerns that may not have been previously considered.

While it may be difficult to revise the BCRA as it stands to ease the concerns of legislators and patients, future healthcare bills should include provisions to expand access to care and reduce costs for patients, according to Dr Westin.

“Healthcare touches everybody’s life. Whether we view ourselves as healthy or unhealthy, everyone is one piece of bad luck away from having some significant health issue,” Dr Westin concluded. “At the end of the day, we all require access to good healthcare. We all want to have good health and be confident that our financial situation is not going to be ruined by having some catastrophe happen.”