NASHVILLE, Tenn. (WVLT) -- Health care advocates are speaking out against a veto by Gov. Bill Haslam on Thursday, May 3, that would require health insurance coverage for state plan members for a type of proton therapy called hyprofractionated proton therapy.
The state already offers certain types of proton therapy, but the bill would have mandated expanded coverage to include hypofractionated treatment, which is essentially more potent and less frequent doses of proton treatment. Providers said the expanded coverage would be at the same cost as traditional radiation therapy.
Don Denton, president of the Tennessee Cancer Patient Coalition, said Gov. Haslam is outsourcing the decision to the state's insuarance company and their unsurer's utilization manager, eviCore Healthcare Management. Denton on May 8 said the state is outsourcing to a third-party service that has a "vested interest in rationing health care."
"Relying on insurance companies to establish coverage guidelines for the latest therapies is obviously a flawed process for cancer patients, given the disparity between eviCore’s proton therapy guidelines covering less than 5% of cancer incidence while Medicare covers over 70% of cancer incidence," Denton said. "This is clearly the case of the fox watching the hen house.”
According to the Tennessee General Assembly, Senate Bill 0367 and House Bill 523, it would not cost the state any more to offer hypofractionated proton therapy. In a fiscal amendment to the bill dated March 26, 2018, it was decided, "Any cost to provide a course of hypofractionated proton therapy will substitute a course of IMRT, and be cost neutral; therefore, this legislation is estimated to have no significant impact on state or local government expenditures associated with those plans."
Many news outlets reported that passage of the bill would result in an increase in cost of health insurance premiums for the proton therapy treatment, and that the bill estimated that each individual's total premium would increase by less than one percent, which would range between $50 for single coverage and $140 for family coverage, depending on types of insurance plans. However that language was amended to indicate the implications of the bill would stay cost neutral.
Provision Proton Center President Tom Welch told WVLT News that was the goal, to give Tennesseans cost neutral access to hypofractionated proton therapy.
“The bill is clearly cost neutral to the State, the cancer patient and the insurance company and places the choice of treatment in the hands of the patient and their physician," Welch said on May 8. "I cannot conceive of a more medically appropriate or fiscally responsible measure than that. The Governor’s veto takes away the patient’s choice and hands it to the insurance companies.”
National Proton Therapy Executive Director Scott Warwick spoke out against Gov. Haslam's veto as well.
"It is clear that the Governor is comfortable allowing eviCore, a for-profit benefit management company, to mandate treatment options to the State’s health plan Members rather than affording them a choice for better treatment," Warwick said. "We urge the Tennessee Legislature, who overwhelmingly supported this bill, to reconvene for a special session to override the Governor’s veto in support of cancer patients across the state.”
On Thursday, Gov. Haslam vetoed the bill, saying, "A bill that circumvents the established process for determining state employee insurance program coverage based on medical evidence and effectiveness. The state plan currently covers many forms of radiation treatment, and the provider advocating this bill rejected a medically appropriate plan for expanded coverage to instead pursue a political mandate. The state is committed to high-quality care that is medically appropriate and fiscally responsible for patients and taxpayers, but this mandate could put patients at risk and expose them to excessive charges from out-of-network providers.”
A spokesperson shared further reasoning for Haslam's decision to veto, "House Bill 0523 contains no protections against balance billing. Balance billing is the practice that would permit Out of Network providers to charge members the difference between the amount paid by the state and what the provider wants to charge. So, while the bill protects the state insurance plan from paying more that what the plan would pay for the conventional radiation treatment (called intensity modulated radiation therapy, or IMRT), it does not protect plan members from getting a surprise bill and being charged the difference by an out of network proton therapy provider."
"In the governor's letter he also says that the patient may be at risk for getting the wrong treatment if this bill were enacted, when in fact there's nothing further from the truth. What this bill does is it puts the treatment in the hands of the patient and their physician. Now with the veto it puts it in control of the insurance company," Welch told WVLT News.
A Governor Haslam spokesperson told WVLT News that the governor vetoed the bill because he was concerned that it did not protect patients from incurring additional costs. That spokesperson said language that would have prohibited balance billing of patients was added then removed from the legislation.
Legislators could override the veto with a simple majority vote. Welch said he was waiting on Lt. Governor McNally to indicate whether a special session would be called to hold the simple majority vote.
McNally and Speaker of the House Beth Harwell released a statement on Haslam's veto:
"While it is the prerogative of the legislature to call for a special session at any time, we believe it would be premature at this point. The 110th General Assembly's final bills are still being enrolled, signed and sent to the governor. The most prudent course is to wait for gubernatorial action on all legislation passed this session. Only then can we reasonably assess the need for a special session."