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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:

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 provided the following comments to the Centers for Medicare and Medicaid Services on the Medicare Drug Price Negotiation Program: Initial Memorandum, Implementation of Sections 1191 – 1198 of the Social Security Act for Initial Price Applicability Year 2026.

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

On June 24, 2022, the U.S. Supreme Court announced its decision in Dobbs v. Jackson Women’s Health Organization, eliminating the constitutional right to abortion and overruling the precedents of Roe and Casey. State actions on access to abortion services could have significant impact on cancer patients. 

This Survivor Views survey finds that cancer patients and survivors continue to face pandemic-related health care delays one year later, including disruptions to screenings and difficulties accessing care.

Where healthcare dollars are spent compared with dollars on cancer care, 2018.

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.

Private Health Insurance Resources:

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.

This report highlights the severe challenges cancer patient may face in paying for life-saving care even when they have private health insurance.

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Costs and Barriers to Care Resources:

The health care law has several provisions that help prevent individuals from experiencing gaps in health insurance coverage, including the requirement that private health insurance plans allow dependents to remain on their parents’ insurance until age 26.  This provision is important for keeping survivors of childhood and young adult cancer insured, and helps to ensure young adults receive preventive services and screenings.  This provision is a crucial patient protection that must be a part of a health care system that works for cancer patients and survivors.

Consumers need access to health insurance policies that cover a full range of evidence-based health care services – including prevention and primary care – necessary to maintain health, avoid disease, overcome acute illness and live with chronic disease.  Any health care system that works for cancer patients must have standards ensuring that enrollees have access to comprehensive health insurance.

Current federal requirements prohibit most insurance plans from limiting both the lifetime and annual dollar value of benefits.  This ban is one of several important patient protections that must be part of any health care system that works for cancer patients.

 

 

ACS CAN comments on 2015 Edition EHR Standards and Certification Criteria Proposed Rule

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Medicaid Resources:

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.

ACS CAN submitted comments regarding Tennessee's latest application to renew their 1115 waiver.

ACS CAN submitted comments to the Centers for Medicare & Medicaid Services regarding its 2022 Request for Information on Access to Coverage and Care in Medicaid & CHIP. Our comments address suggested improvements in Medicaid enrollment and eligibility determination, transitions of coverage, national standards for access to care, and the eventual end of the public health emergency and continuous coverage provisions.

ACS CAN submitted comments in support of the renewal of Oregon's 1115 Medicaid waiver, including the state's proposal of continuous coverage provisions for children and adults. However, ACS CAN strongly objects to the state's proposal to limit Medicaid coverage of drugs approved through the accelerated approval process, and urges CMS to reject this part of the waiver request.

ACS CAN submitted comments opposing Tennessee's proposal to fund its Medicaid program through a block grant and implement a closed formulary.