Bill Overview
Title: Clinical Trial Coverage Act of 2022
Description: This bill requires health insurance plans (including Medicare) to cover out-of-network routine care for clinical trial participants at the in-network rate when an in-network provider is not available.
Sponsors: Rep. Speier, Jackie [D-CA-14]
Target Audience
Population: Participants in Clinical Trials and Potential Participants
Estimated Size: 5000000
- Clinical trials are a key component of medical research which involves patient participation from diverse backgrounds.
- The bill impacts not only current participants of clinical trials but also future participants as it changes the insurance landscape for routine care coverage.
- The broader population that would consider joining a clinical trial may be further encouraged by reduced financial barriers.
Reasoning
- The U.S. has a significant number of individuals participating in clinical trials, often featuring diverse populations.
- This policy change could primarily benefit people currently in trials or those considering joining, due to reduced out-of-pocket expenses.
- Higher encouragement among populations, especially those with Medicare, could lead to increased participation in trials over time.
- Focusing on a representative sample should reveal varied impacts based on the individual's circumstances such as type of insurance and health conditions.
Simulated Interviews
Retired (Florida)
Age: 67 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 6.0 years
Commonness: 6/20
Statement of Opinion:
- I was worried about the costs associated with being in a trial.
- This new law helps since I'm on Medicare and my providers were all out-of-network.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 8 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
Software Engineer (California)
Age: 45 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 15/20
Statement of Opinion:
- The cost of the treatment was something I worried about, but this policy makes participating in trials easier.
- Knowing I won't face unexpected expenses is a relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Homemaker (Ohio)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 7/20
Statement of Opinion:
- Before this, any out-of-network charges were a concern.
- The policy eases my financial worries, allowing me to continue participating.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 2 |
Graduate Student (New York)
Age: 30 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 12/20
Statement of Opinion:
- While funding is a constant worry, this makes participating less daunting.
- Seeing routine care covered makes trials more appealing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Truck Driver (Texas)
Age: 50 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 10/20
Statement of Opinion:
- This gives me peace of mind should I decide to join a trial.
- Insurance has always been tricky, and this removes a barrier.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
High School Teacher (Illinois)
Age: 56 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 14/20
Statement of Opinion:
- I've always wanted to contribute to research but feared potential costs.
- Policies like these reassure me about pursuing trials.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Marketing Specialist (New Jersey)
Age: 40 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 20/20
Statement of Opinion:
- For now, this doesn't change much for me.
- I see its value for those needing trials, which might include me someday.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Retired Engineer (Arizona)
Age: 65 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 8/20
Statement of Opinion:
- This policy encourages people my age to consider research trials.
- It might not affect me directly now, but it's a positive change for the community.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Veterinary Technician (North Carolina)
Age: 28 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 4.0 years
Commonness: 11/20
Statement of Opinion:
- I'm intrigued by these trials, especially now that costs are covered.
- It's an opportunity to improve health and contribute to research without financial fear.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 6 | 4 |
| Year 20 | 5 | 3 |
University Professor (Massachusetts)
Age: 60 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 3.0 years
Commonness: 9/20
Statement of Opinion:
- Having solid insurance meant costs were already covered for me.
- But overall, it's a boon for those with less coverage.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 7 |
Cost Estimates
Year 1: $450000000 (Low: $350000000, High: $600000000)
Year 2: $375000000 (Low: $290000000, High: $470000000)
Year 3: $350000000 (Low: $270000000, High: $440000000)
Year 5: $325000000 (Low: $250000000, High: $400000000)
Year 10: $300000000 (Low: $230000000, High: $370000000)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- Compliance from insurance providers and speed of policy implementation will be key determining cost factors.
- Potential reduction in financial barriers might increase participation in clinical trials, accelerating medical advancements.
- Administrative and claim management costs could initially increase for health plans.