Community Oncology Alliance Releases a Comprehensive Legislative Framework for Health Care Reform

COA offers a roadmap for Congress to stabilize the U.S.'s health care system, protect patients, and restore competition in care delivery

WASHINGTON, Feb. 5, 2025 /PRNewswire/ -- The Community Oncology Alliance (COA) announced today the release of the COA Prescription for Health Care Reform, a comprehensive blueprint that diagnoses the fundamental challenges facing our health care system, outlines the consequences for patients across America, and presents actionable solutions that Congress must act on now to address these urgent issues. Through the "prescription," COA identifies key legislative priorities and recommends "treatments" that ensure patients have access to the highest quality, most affordable medical care in their own communities. 

"Our health care system has reached a critical tipping point as Americans pay more than ever for health care that is becoming increasingly out of reach. Consolidation, administrative burdens, and skyrocketing costs are hurting patients and providers alike," said Debra Patt, MD, PhD, MBA, FASCO, president of COA and a practicing breast cancer specialist in Austin, Texas, and executive vice president at Texas Oncology. "As stewards of our cancer care system, we feel it is our duty to provide Congress with a blueprint for meaningful reform that protects independent community medical practices and the millions of patients they care for."

Each section of the COA Prescription for Health Care Reform focuses on a critical aspect of reform —ranging from curbing consolidation and strengthening the health care workforce to ensuring access to life-saving therapies and modernizing outdated Medicare policies. Structured as a five-part plan, each section diagnoses the root causes of inefficiencies, inequities, and rising costs while providing detailed, practical treatments to stabilize the system and prioritize patients.

The five-part legislative framework addresses:

• Hospitals and Health System Consolidation: For too long, hospitals have been permitted to consolidate into monopolistic mega "nonprofit" systems that raise costs, reduce provider choice, and limit competition. Reform must begin with site-neutral payment policies to ensure fairness in reimbursements, an overhaul of 340B to ensure patients are benefiting as Congress originally intended, an examination of what a "nonprofit" institution means, and restrictions on aggressive debt collection practices.
• Insurance and Pharmacy Benefit Manager (PBM) Consolidation and Market Dominance: Insurers and their increasingly owned or operated PBMs wield disproportionate power, inflating costs, and limiting access. Transparency in PBM operations, accountability for formulary practices, and protections against prior authorization (PA) delays are critical. Laws must prevent PBMs from steering patients toward affiliated pharmacies or imposing mandatory mail order requirements. 
• Fixing Physician Reimbursement and Workforce Shortages: Independent medical practices are buckling under outdated Medicare reimbursement models. Immediate reforms should halt Medicare Physician Fee Schedule (MPFS) cuts, align reimbursements with inflation, and eliminate harmful payment sequestration. To address workforce shortages, Congress must expand residency positions, offer incentives for rural practice, and ensure that reimbursement models adequately support practices in underserved areas. 
• Ensuring Access to Oncology Therapies (Drugs): Rising drug costs, chronic shortages of generic sterile injectable (GSI) drugs, and uncertainty in the biosimilar market jeopardize access to affordable cancer therapies. Reforms must address supply chain issues, stabilize pricing for GSIs and biosimilars, and technically fix the Inflation Reduction Act (IRA) to protect independent medical practices from financial harm due to Medicare price negotiations.
• Modernizing Structural CMS Medicare Policies: Medicare's fragmented and outdated payment system perpetuates inefficiencies and fuels consolidation. A payment approach that better balances equitable reimbursements across hospitals and independent practices is essential to a level, free market playing field. Oversight of the Center for Medicare and Medicaid Innovation (CMMI) must also be strengthened to ensure its models align with patient-centered care and do not exacerbate administrative burdens or encourage consolidation.

"We are at a critical point in the nation's health care system. If Congress does not act soon to address unfettered consolidation and continues to allow these issues to go unchecked, we'll see worse outcomes for patients, higher costs, and fewer choices," said Ted Okon, executive director of COA. "The COA Prescription for Health Care Reform provides actionable recommendations for congressional action now during the 119^th Congress and beyond that will improve all areas of the U.S.'s health care system. The time for action is now!"

Aligning with COA's mission, the COA Prescription for Health Care Reform points to actionable legislative reforms that the current and future Congress can take to ensure patient access to high-quality, affordable medical care, and safeguards the financial sustainability of the health care system for patients and those who care for them.

While the framework is rooted in the experience of community oncology practices, the systemic issues it addresses—consolidation, inequitable payment structures, workforce shortages, escalating costs, and access barriers—are universal across all of health care. Oncology serves as a lens for broader reform because it is one of the most multifaceted areas of health care, encompassing complex care delivery, diverse treatment modalities, and interactions with every aspect of the health care system. Grounded in more than two decades of experience advocating for independent community oncology, the COA Prescription for Health Care Reform draws on insights from oncologists, pharmacists, practice administrators, and other health care experts.

Read the full Prescription at https://mycoa.communityoncology.org/education-publications/report/coa-prescription

About the Community Oncology Alliance 

The Community Oncology Alliance (COA) is a nonprofit organization dedicated to advocating for community oncology practices and, most importantly, the patients they serve. COA is the only organization dedicated solely to community oncology where the majority of Americans with cancer are treated. The mission of COA is to ensure that patients with cancer receive quality, affordable, and accessible cancer care in their own communities. Learn more about COA at www.communityoncology.org.

SOURCE Community Oncology Alliance