In one way or another, cancer has touched all of our lives. A loved one, a neighbor, a friend, a role model. Someone we know is fighting cancer. As it stands, cancer is a vicious enemy, a brutal fact of life. But we are making progress, and someday we will put cancer in its place. We will prevent it and we will cure it.

Medical research is the lynchpin. And needless barriers to research are a deadly setback. I’m introducing legislation today that confronts one of those barriers: unjustifiable out-of-pocket costs. Here’s what happens: An insurer sells you a policy on the premise that the policy covers medically necessary routine care. Virtually all health plans do. Then you enroll in a clinical trial. Suddenly, your insurer refuses to cover routine health care costs, even if those costs have nothing to do with the clinical trial itself. It deters people from enrolling in clinical trials, which thwarts medical research and chokes off hope for patients who have exhausted all their other options.

I am introducing the Access to Cancer Clinical Trials Act to prevent insurers from establishing illogical, unethical, insupportable coverage exclusions for routine care — care that is not associated with a clinical trial, but that happens to coincide with it. This bill is a true Ohio effort — Ohio Congresswoman Deborah Pryce (R), a leader in the area of cancer research, has championed this legislation in the House. I am introducing the Senate companion to advance her vision and pave the way for more cancer clinical trials.

Our bill obligates health plans to pay for routine care costs when a cancer patient enrolls in a clinical trial. These are costs that would normally be covered if a cancer patient were not participating. The legislation is very specific in its definition of routine care costs to make it clear that clinical trial-related care would still be covered by the trial itself, as would the costs of any complications related to the trial. It is equally clear in stopping health plans from treating cancer patients like second class citizens, dashing their hopes and compromising the public health.

Last year, Sheryl Freeman and her husband, Craig, of Dayton, Ohio, visited my office in Washington, D.C. Sheryl had multiple myloma. Sheryl and Craig brought to my attention the problems they were having with their insurance company. Sheryl was a retired school teacher and was covered under Craig’s insurance plan. Craig has been a federal employee for 20 years and has one of the best health plans in the country. Yet when Sheryl tried to enroll in a clinical trial, her insurance company would not cover the routine costs of her care. In addition to her clinical trial in Columbus, Sheryl needed to visit her oncologist in Dayton at least once a week for standard cancer monitoring, which included scans and blood tests. But her insurance company would not cover these services if she enrolled in a clinical trial.

Sheryl wanted to take part in a clinical trial because she hoped it would help her. She hoped that it might save her life, give her more time, or advance cancer research. But rather than devoting her energy toward combating cancer, Sheryl spent the last months of her life haggling with her insurance company. The delays and denials from Sheryl’s insurance company probably affected her treatment and her survival. Sheryl died on December 9 of last year. This story should have ended differently. Sheryl and Craig should not have had to sacrifice their precious time together trying to get the care she deserved, the care she paid for when she signed up for health insurance.

On Monday of this week, I met another cancer patient, Merle Farnsworth, from Beverly, Ohio. Merle has lymphoma. For him, clinical trials signify hope. Hope for the future, hope for others who are fighting cancer, hope for a cure. As we take a closer look at cancer today, I will be thinking of Merle and Sheryl. No one should be robbed of hope by an insurance loophole. No one.

This entry was posted on Friday, May 9th, 2008 at 1:35 pm and is filed under Politics, Healthcare .