Cancer-testing bill being debated at Ohio Statehouse

COLUMBUS, Ohio (WCMH) -- A bill at the Ohio Statehouse would require health benefit plans and Medicaid to cover “medically necessary” tests used to determine a patient’s cancer diagnosis. 

Biomarker testing is used on cancer patients, for example, helping doctors more specifically determine to target a specific patient’s cancer directly, rather than using generalized treatments.

“I have gone through thousands of biopsies, hundreds of surgeries encompassing my entire body,” American Cancer Society Cancer Action Network volunteer Leah McCleary said. “Eighty-nine of those surgeries have been from my neck up alone. I've done chemotherapy twice, clinical trials. The list goes on and on. Had I had access to this test years ago, I would have avoided years worth of treatments that were painful and expensive that inevitably didn't work best for my body's needs.” 

McCleary was diagnosed with a rare form of skin cancer when she was nine years old and is still in active treatment to this day.    

“I have been fighting cancer for 20 years now,” she said.    

McCleary, alongside her seven-year-old son, has been advocating for the passage of House Bill 24.    

“Being a cancer fighter for the last 20 years, it's important for my lawmakers to know that my voice matters and cancer impacts my life deeply and impacts my son and our lives together,” she said. “I'm not a number on a spreadsheet. I'm a patient, I'm an advocate, and I think it's important for them to hear those stories.”  

Not everyone is quite on board with the idea. Chris Ferruso, state director for the Ohio chapter of the National Federation of Independent Business (NFIB), said he understands its importance.

“First and foremost, the important thing we are talking about here is people and patients and outcomes and our members want to make sure that their patients get the treatment they need,” he said. 

While Ferruso acknowledges that opposition to the bill is “not popular,” it is more complicated than it seems.    

“It's a struggle to provide,” he said. “We just want policymakers to be aware that there will be upward pressure put on premium.”    

Ferruso said the bill would only impact about 12% of the private sector, but his biggest concern is the way the legislation is currently drafted, saying it isn’t clear enough. 

“At least the way we interpret it, that any new test that comes on the market so long as it meets the criteria delineated in the bill, will be required to be covered under this state law, and that’s where our concern lies,” he said. “We know the cost of the test today. We don't know what those tests cost in the future and so, when there's a state mandate put in place, it kind of tips that scale in favor of one side versus the other.”

Ferruso said while he cannot say that this legislation will cause companies to lay people off, he said it could still result in some difficult decisions.   

“Do they move to a plan that has a higher deductible or a greater cost-sharing requirement?” he said. “Do they ask employees to contribute a greater percentage of premiums, and in a worst-case scenario, do they make the ultimate decision that, ‘Look, I can no longer provide this benefit, it's just too costly.’ The pie is only so big.”  

Ferruso said he would favor some sort of cap to ensure that costs “don’t run away and go crazy.”

“What we'd like to see is the General Assembly look at perhaps Medicare as a benchmark and allow some sort of delta from Medicare, whatever that number is, 30, 50, 100% above Medicare reimbursement as a means to ensure that these tests do get covered,” he said.   

Ferruso said he has been able to work closely with the bill’s sponsor and is grateful for the open-mindedness. He said if they were able to achieve such an amendment to the bill, the NIFB would take a neutral stance instead of opposition.

McCleary said cancer treatment has advanced so much in the past several years and now is not the time to stop. 

“It's important that we continue to pave that path forward for people like myself who are in active treatment for cancer, but also the millions of other Americans that are going to hear those words, ‘You have cancer’ just this year alone,” McCleary said.    

The bill has its third hearing in the Ohio Senate Insurance Committee on Wednesday afternoon. Opponents will have the chance to testify on Wednesday; Ferruso said he plans to do so, in hopes of convincing members to amend the bill.