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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:

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:

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:

ACS CAN offered comments on the following proposals:

ACS CAN offered comments on the following policies:

On Monday, April 29th, ACS CAN submitted comments in response to CMS' Medicare Prescription Payment Plan model notices. 

 

This ACS CAN chartbook provides cancer-specific data related to Medicare, including basic information about the program, a discussion of its components, characteristics of enrollees, coverage of services – specifically those related to prevention and screening – program expenditures and enrollees

The American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN) along with partners appreciate the opportunity to comment on the Patient Navigation provisions of CY2024 Medicare Physician Fee Schedule.

Costs and Barriers to Care Resources:

A majority of cancer patients and survivors struggle to afford cancer care and over 80% have had to make financial sacrifices to cover their health care expenses. This survey also reveals ways that affordability concerns can negatively impact care and treatment, and explores issues related to prescription drug coverage and pain management options.

In these comments, ACS CAN strongly supports Congress’ and the Administration’s efforts to protect patients from surprise medical bills and we are encouraged by the important steps this interim final rule takes. Specifically, we applaud the Departments’ proposed policies related to:

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.

Cancer patients are particularly vulnerable to spikes in their health care costs because many expensive diagnostic tests and treatments are scheduled within a short period of time, so cancer patients spend their deductible and out-of-pocket maximum quickly. These costs can be difficult to manage over the course of a year, and most monthly budgets simply can’t afford these large bills. 

Most patients experience spikes in their health care costs around the time of a cancer diagnosis as they pay their deductible and out-of-pocket maximum. For patients on high deductible plans, this spike can mean bills due for several thousands of dollars within one month.

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 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 report explores the experiences of cancer patients with their health insurance and financial challenges through interviews with hospital-based financial navigators. The report finds that while the Affordable Care Act has brought crucial improvements to patient access to health insurance, cancer patients still face serious challenges affording their care and using their insurance benefits.

Current federal requirements prohibit health insurance plans from denying coverage to individuals with pre-existing conditions like cancer.  These are one of several important patient protections that must be part of any health care system that works for cancer patients.

Medicaid Resources:

ACS CAN submitted comments supporting the Rhode Island Medicaid program providing coverage to justice-involved populations and housing and nutritional supports to enrollees. 

ACS CAN submitted comments supporting Colorado's request to amend it's 1115 Medicaid waiver to establish continuous eligibility for children up to age 3, and other policies.

ACS CAN submitted comments to CMS in support of Pennsylvania's application for an 1115 Medicaid waiver to provide continuous eligibility to children, provide targeted coverage to justice-involved populations, and provide housing and nutrition supports to Medicaid enrollees.

ACS CAN submitted comments to the Centers for Medicare and Medicaid Services supporting Hawaii's proposal to provide continuous eligibility for Medicaid to children through age 6, and 2-year eligibility ages 6-19. We also supported their proposal to provide pre-release services to justice-involved individuals.

ACS CAN submitted comments to the Centers for Medicare and Medicaid Services in support of Minnesota's request to provide continuous eligibility for Medicaid to children up to age 6, and 12-month continous eligibility to 19- and 20-year-olds.