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Access to Health Care

ACS CAN advocates for policies that provide access to treatments and services people with cancer need for their care - including those who may be newly diagnosed, in active treatment and cancer survivors.

Access to Health Care Resources:

The U.S. spent approximately $183 billion on cancer-related health care in 2015. This represents a signification portion of the total health care spending in the U.S. And it is expected to keep growing. By 2030 cancer-related health care spending is expected to reach nearly $246 billion.

The upheaval to the U.S. economy caused by the pandemic has resulted in many Americans losing their jobs and their employer-provided health insurance. Mid-year coverage disruptions are costly because cancer patients like Franklin who have already met their deductible and maximums near the beginning of the year must pay another deductible and reach their new maximum out-of-pocket amount when they start their new insurance plan.

The Affordable Care Act (ACA) has helped individuals with pre-existing conditions like cancer access comprehensive health insurance and afford their care. But the law is at risk of being dismantled.

This Survivor Views survey examined access to and affordability of cancer care. Survivors report insurance-related barriers to obtaining prescriptions, and lower-income respondents in particular have difficulty affording them.  24% of respondents have received a surprise medical bill, 60% of which were more than $500.

This Survivor Views survey examined cancer symptoms and side effects, including pain, and use of palliative/ supportive services. Cancer survivors report many physical and emotional side effects during and after treatment, but use of solutions to address those symptoms is lagging.  Survivors prescribed opioids often encounter barriers to obtaining them.

ACS CAN responded to the reopening of the Centers for Medicare and Medicaid Services (CMS) coverage decision for NGS testing panels.

This ACS CAN report focuses specifically on the costs of cancer borne by patients in active treatment as well as survivors.  It examines the factors contributing to the cost of cancer care, the type of direct costs patients pay, and the indirect costs associated with cancer.

This analysis examines two issues of particular interest to the American Cancer Society Cancer Action Network (ACS CAN) and its members: the extent of coverage and cost-sharing for cancer drugs, and whether information on the coverage of cancer drugs can be readily obtained, compared, and understood by patients.

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Prescription Drug Affordability Resources:

Biological drugs, commonly referred to as biologics, are a class of drugs that are produced using a living system, such as a microorganism, plant cell, or animal cell. Like all drugs, biologics are regulated by the United States Food and Drug Administration (FDA).

For an individual with specific health care needs – like cancer patients and survivors – the drugs covered by a health plan and corresponding cost sharing for each drug is important information when choosing health insurance. However, to make an informed choice, formulary information must be disclosed to the individual.

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Private Health Insurance Resources:

ACS CAN submitted comments regarding marketplace insurance plans and requirements for plan year 2023. 

High deductible health plans (HDHPs) and health savings accounts (HSAs) are becoming more common in employer-sponsored insurance and the individual and small group markets.  These types of plans have risks and features must be implemented carefully so they do not harm cancer patients, survivors or those at risk for cancer.

ACS CAN submitted comments regarding the 2020 Proposed Notice of Benefit & Payment Parameters for the individual insurance market.

ACS CAN submitted comments on the proposed 2019 CMS Program Integrity Rule.

ACS CAN submitted comments regarding a proposed rule to change Health Reimbursement Arrangements (HRAs) and other account-based group health plans.

In 2015, the American Cancer Society Cancer Action Network (ACS CAN) analyzed coverage of cancer drugs in the health insurance marketplaces created by the Affordable Care Act (ACA) and found that transparency of coverage and cost-sharing requirements were insufficient to allow cancer patients to choose the best plan for their needs.

This analysis examines two issues of particular interest to the American Cancer Society Cancer Action Network (ACS CAN) and its members: the extent of coverage and cost-sharing for cancer drugs, and whether information on the coverage of cancer drugs can be readily obtained, compared, and understood by patients.

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Medicare Resources:

Earlier screening for cancer is important because when detected at later stages, treatments are more limited, and outcomes are generally poorer. Medicare enrollees should have access to multi-cancer screening tests when the benefit is clinically shown.

Cancer patients and survivors must balance reducing their health care costs with ensuring they have comprehensive coverage of services, treatments, and care providers.

The incidence of cancer increases with age and thus the Medicare program is vitally important to millions of Americans who are undergoing active cancer treatment, are cancer survivors or who have not yet developed cancer.

ACS CAN Comments to Seema Verma, Administrator, Centers for Medicare and Medicaid Services

ACS CAN submitted comments on the Medicare Part C and D Rule.

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Medicaid Resources:

What does unwinding continuous coverage have to do with Medicaid expansion?

  • During the pandemic, Congress put in place continuous coverage protections to ensure that Medicaid enrollees were able to keep their health coverage without needing to re-enroll.

What does unwinding continuous coverage have to do with Medicaid expansion?

  • During the pandemic, Congress put in place continuous coverage protections to ensure that Medicaid enrollees were able to keep their health coverage without needing to re-enroll.

What does unwinding continuous coverage have to do with Medicaid expansion?

  • During the pandemic, Congress put in place continuous coverage protections to ensure that Medicaid enrollees were able to keep their health coverage without needing to re-enroll.

What does unwinding continuous coverage have to do with Medicaid expansion?

  • During the pandemic, Congress put in place continuous coverage protections to ensure that Medicaid enrollees were able to keep their health coverage without needing to re-enroll.

What does unwinding continuous coverage have to do with Medicaid expansion?

  • During the pandemic, Congress put in place continuous coverage protections to ensure that Medicaid enrollees were able to keep their health coverage without needing to re-enroll.

ACS CAN strongly opposes any attempt by the federal government or states to condition Medicaid coverage on work or community engagement.

ACS CAN opposes per capita caps, block grants, and other capped funding structures for the Medicaid program, as they endanger access to care.

Cancer patients and survivors must balance reducing their health care costs with ensuring they have comprehensive coverage of services, treatments, and care providers.

ACS CAN submitted comments strongly supporting several policy changes that will make it easier to apply for, enroll in, and maintain enrollment in Medicaid and CHIP.