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:

On Tuesday, January 19, ACS CAN submitted comments in response to the Most Favored Nation (MFN) interim final rule with comments. 

Telehealth visits that enable providers to deliver clinical services from a distance using options like video conferencing and remote monitoring can provide cancer patients and survivors with a convenient means of accessing both cancer care and primary care.

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 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.

ACS CAN encourages policymakers at all levels to continue exploring this issue. ACS CAN supports policies at the national, state and local levels that increase access to job-protected paid family & medical leave that can be used for cancer treatments, survivorship care, and caregiving as well as other illnesses. Read this factsheet to learn more.

The American Cancer Society Cancer Action Network (ACS CAN) appreciates the opportunity to comment on the 2021 Notice of Benefit and Payment Parameters proposed rule. ACS CAN is making cancer a top priority for public officials and candidates at the federal, state, and local levels.

Prescription Drug Affordability Resources:

Many cancer patients take multiple drugs as part of their treatment – often for many months or years. While drugs are not the only costly part of cancer treatment, finding ways to reduce these costs for patients and payers will significantly reduce the overall cost burden of cancer.

Many cancer patients have difficulty affording the cost of their prescription drugs, regardless of whether they are insured.  This is especially true for newer drugs that do not have a generic equivalent.  Many programs exist to help patients afford their medication.  This fact sheet focuses on two of these – patient assistance programs and discount coupons.  

ACS CAN joined organizations representing cancer patients, survivors, providers, and caregivers urging the administration to address barriers to access to care and coverage during the public health crisis

ACS CAN joined 50 groups representing, cancer patients, survivors, doctors, nurses, cancer centers, pharmacists and researchers urging Congress to address barriers to patient access to care and coverage.

The Medicare Access for Patients Rx (MAPRx) Coalition raises concerns about proposed changes to the Medicare prescription drug benefit and Medicare Advantage plans

The American Cancer Society Cancer Action Network (ACS CAN) appreciates the opportunity to comment on the 2021 Notice of Benefit and Payment Parameters proposed rule. ACS CAN is making cancer a top priority for public officials and candidates at the federal, state, and local levels.

ACS CAN supports legislative and regulatory policies at the state and federal level that prohibit patients from being surprise billed for unexpected out-of-network care.

ACS CAN comments to Secretary Alex Azar on Drug Rebate Proposed Rule

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).

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 on September 16, 2020, to CMS regarding Georgia's 1332 waiver application.

The American Cancer Society Cancer Action Network (ACS CAN) appreciates the opportunity to comment on the 2021 Notice of Benefit and Payment Parameters proposed rule. ACS CAN is making cancer a top priority for public officials and candidates at the federal, state, and local levels.

ACS CAN applauds the intent of the proposed rule, which is to provide consumers with information regarding their expected out-of-pocket health care costs for items and services before they receive care.

ACS CAN Comments on Rhode Island 1332 Reinsurance Waiver Proposal

ACS CAN Comments on Montana 1332 Reinsurance Waiver Proposal

Medicare Resources:

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

Letter in support of Medicare coverage for CAR-T therapies.  

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

Approximately 1.7 million new cancer cases are expected to be diagnosed in 2018. Age is one of the most important risk factors for cancer, with one half of cancer cases occurring in people over the age of 65.

Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates.

On January 16, 2018, ACS CAN filed comments in response to CMS’ proposed rule implementing changes to the Medicare Part C and Part D programs. ACS CAN commented on a number of proposed policies.

ACS CAN submitted comments regarding the Centers for Medicare and Medicaid Services' Survey called Innovation Center New Direction. The comments addressed: advanced alternative payment models, consumer-directed care & market-based innovations, physician specialty models, prescription drug models, and Medicare Advantage models.

Reducing Health Disparities Resources:

Research shows that while overall cancer mortality rates in the U.S. are dropping, populations that have been marginalized are bearing a disproportionate burden of preventable death and disease. Researchers and policymakers need timely collection and publication of demographic data to identify disparities to improve health equity in cancer prevention, detection, and treatment.

Telehealth can help to reduce health disparities and improve health outcomes for all individuals, regardless of race, ethnicity, gender, age, sexual orientation, socioeconomic status, or zip code by providing cancer patients with a means of accessing both cancer care and primary care.

Despite notable advances in cancer prevention, screening, and treatment, not all individuals benefit equally from this important progress. This fact sheet provides an overview of current health disparities in cancer care and a snapshot of ACS CAN federal advocacy activities to eliminate these disparities and achieve health equity.

In order to reduce cancer mortality we must fight to achieve health equity, the just and fair opportunity for everyone to prevent, find, treat and survive cancer. This document shows a snapshot of how ACS CAN is fighting for health equity at the national, state and local levels.

Research is critical to understanding and reducing cancer disparities, as well as examining gaps in cancer prevention and care delivery that contribute to these disparities. Clinical trials are a key part of research and enable the development of better drugs and treatments for cancer.

All individuals should have equitable access to quality cancer care and equal opportunity to live a healthy life. Our ability to continue to make progress against cancer relies heavily on eliminating the inequities that exist in cancer care.

Although tobacco-related cancer incidence and mortality have declined in the U.S., we continue to see disparities by socioeconomic status (SES), race/ethnicity, educational level, gender, sexual orientation, and geographic location. Our ability to continue to make progress against cancer relies h

Our ability to continue to make progress against cancer relies heavily on eliminating the inequities that exist in the prevention and early detection of cancer. This factsheet explores how health outcomes vary across groups, barriers to cancer screenings, and how ACS CAN is taking action.

In response to a request from FDA, ACS CAN has provided recommendations for areas of focus for the Office of Minority Health and Health Equity (OMHHE).  Recommendations include assessing the applicability of drug "snapshot" data, evaluating the appropriateness of aggregating racial groups for ana

Costs and Barriers to Care Resources:

Many patients with complex diseases like cancer find it difficult to afford their treatments – even when they have health insurance.  Current law establishes a limit on what most private insurance plans can require enrollees to pay in out-of-pocket costs.  These limits protect patients from extremely high costs and are essential to any health care system that works for cancer patients and survivors.

 

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.

Short-term limited duration (STLD) insurance plans do not provide the kind of comprehensive insurance coverage cancer patients need.  These plans were designed only as temporary coverage and are not subject to the same Affordable Care Act (ACA) requirements as other health insurance products on the market.  As a result, an enrollee who was attracted to the plan’s lower premiums may find – if they are diagnosed with a serious illness like cancer – that the plan does not cover all of their necessary cancer treatments.  In these cases, the consumer can be left with catastrophic costs.

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.

ACS CAN supports legislative and regulatory policies at the state and federal level that prohibit patients from being surprise billed for unexpected out-of-network care.

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.

Medicaid Resources:

ACS CAN comments on Georgia's 1115 Demonstration Waiver.

ACS CAN comments on Nebraska's 1115 Demonstration Waiver.

An increasing number of states are seeking greater flexibility in administering their Medicaid programs. The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) give states the opportunity to test innovative or alternative approaches to providing health care coverage to their Medicaid populations through Section 1115 Research and Demonstration Waivers (otherwise known as "1115 waivers"). States must demonstrate that their waivers promote the objectives of the Medicaid and Children’s Health Insurance Programs (CHIP) and CMS must use general criteria to determine whether the objectives of the Medicaid/CHIP programs are met.

 

Medicaid is the primary health insurance program for low-income Americans, offering quality, affordable, and comprehensive health care coverage to millions of people including those with cancer, those who will be diagnosed with cancer, and cancer survivors. Having health insurance through Medicaid helps Americans stay healthy, go to work, care for their families and pay their bills. The Medicaid program also helps communities, hospitals, schools, and economy thrive.

ACS CAN comments on Tennessee's 1115 Demonstration Waiver.

ACS CAN comments on Utah's 1115 Demonstration Waiver.

ACS CAN Comments on Idaho's 1115 Demonstration Waiver.

ACS CAN Comments on Montana's 1115 Demonstration Waiver.

ACS CAN Comments on Utah's 1115 Demonstration Waiver