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:

 

Federally Qualified Health Centers (FQHCs) are an integral part of the health care safety-net, providing access to affordable primary care services for nearly 26 million uninsured or underinsured Americans many of whom have cancer. The centers are non-profit, community-directed, and serve high need rural and urban communities that face obstacles to health care, including cost and lack of insurance, as well as geographic and language barriers. FQHCs provide access to quality preventive and primary care services that are critical for cancer patients, survivors, and those who will be diagnosed with cancer.

On April 25, 2017, the text of an amendment to the American Health Care Act (AHCA) to be offered by Representative MacArthur (R-NJ) was released.  The amendment could undo several key protections that are critical for cancer patients and survivors – including the prohibition on pre-existing condition exclusions.

Since passage of the health care law in 2010 there have been significant changes in health insurance that have protected patients.  This fact sheet provides information on how changes to the health care market have directly affected the United States.

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.

Reducing the cancer burden depends on access to meaningful health coverage for all Americans. ACS CAN created an infographic to help illustrate the difference between having access to affordable, adequate coverage and facing barriers to care when facing a cancer diagnosis.

Provides information on health insurance options, tax credits and subsidies in every state. Consumers may be able to submit an application for health insurance directly through this site.

Provides information about enrolling in Medicare, including Part D prescription drug coverage, what Medicare covers, and how to contact Medicare with questions

Resources and information from the American Cancer Society about understanding health insurance, particularly for cancer patients and survivors.

The American Cancer Society operates a call center available to all cancer patients and their families, that includes resources and specialists who can help patients with questions about health insurance, enrolling in a plan, and issues accessing care.

Workforce Resources:

These comments submitted to the Institute of Medicine’s Committee on the Governance and Financing of Graduate Medical Education address ways to ensure an adequate and appropriate cancer care workforce to treat cancer patients.

Private Health Insurance Resources:

The Affordable Care Act (ACA) expanded access to health insurance through reforms of the private health insurance market, including income-related premium support and cost-sharing subsidies and establishment of Health Insurance Marketplaces.

Information about prescription drug formularies

It is critically important for cancer patients to be able to access clear, consistent, and comparable information on prescription drug coverage, including coverage of physician-administered drugs, in order to choose a health plan. Prior to the Affordable Care Act (ACA), such information was not widely available, but various ACA provisions aim to improve the comprehensiveness, comparability, and transparency of health plan benefits.

In this 2014 white paper, ACS CAN examined the extent of coverage and cost-sharing for cancer drugs in silver Marketplace plans in selected states and whether information on the coverage of cancer drugs can be readily obtained, compared, and understood by patients.

Utilization management is a collection of treatment review and cost reduction techniques used by health insurers and health plans.

ACS CAN filed comments to the Department of HHS on the proposed rule regarding data collection and support standards related to the collection of data for Essential Health Benefits.

In a letter to President Obama, ACS CAN and other consumer groups urged the Adminstration to promptly, effectively, and fully implement the Summary of Benefits and Coverage rule.

In a letter to HHS Secretary Sebelius, ACS CAN and other organizations urged HHS to provide additional specific information on proposed state benchmark plans.

In a letter to Congress, ACS CAN and other organizations urged the rejection of legislation that would undermine the critical consumer benefits provided by the ACA's minimum loss ration requirements.

Medicare Resources:

ACS CAN commented on the Medicare CY2015 Physician Fee Schedule, in which we urged, among other things for CMS to designate screeming colonoscopioes that resule in polyp removal or biopsy as a preventive service.

ACS CAN commented in the FY2015 Medicare Hospice payment rule, in which we urged, among other things, for Medicare to develop a workable solution to better clarify when a prescription drug is covered under the Hospice or Part D benefit.

ACS CAN commented in the FY2015 Medicare Hospice payment rule, in which we urged, among other things, for Medicare to develop a workable solution to better clarify when a prescription drug is covered under the Hospice or Part D benefit.

ACS CAN filed comments in response to the Center for Medicare & Medicaid Innovation's (CMMI's) request for information on specialty practitioner payment model opportunities.

In a letter to CMS Administrator Tavenner, ACS CAN joined other organizations urging CMS to reqire Medicare Advantage plans to provide coverage for clinical trials.

ACS CAN filed extensive comments in response to CMS' proposed rule implementing changes to the Medicare Part C and D programs, including opposing proposed changes to the Part D six protected classes.

In this 2013 report ACS CAN explored the relationship between Medicare and cancer, including how cancer affects the elderly and the financial impact the disease has on the Medicare program and its beneficiaries.

ACS CAN commented on CMS' Accountable Care Organizations (ACOs) proposed rule. Our comments offered specific recommendations to improve the ACO program to better serve the needs of cancer patients and survivors.

Cancer patients and others who may suffer from multiple chronic conditions or long-term side effects from treatment would benefit from payment reform in Medicare.

Health Care Delivery Resources:

Current federal law has several provisions that help prevent individuals and families from experiencing gaps in their health insurance coverage.  Coverage gaps can delay necessary care, which is particularly detrimental to cancer patients and survivors.  Preventing gaps in coverage is a crucial patient protection that must be maintained in our health care and insurance system.

Current federal law provides life-saving coverage of cancer prevention and early detection services and programs.  These provisions are crucial to reducing the incidence and impact of cancer in the United States.  They are also crucial in helping cancer survivors remain cancer-free and lead healthy lives.

The Medicare program covers 55.3 million people, including 46.3 million who qualify due to age and 9 million people who qualify on the basis of a disability.  Medicare beneficiaries - including many cancer patients and survivors - have access to an outpatient prescription drug benefit that provides them with prescription drugs needed to treat their disease or condition.  This benefit – and keeping it affordable – are crucial 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 are not without risk and features must be implemented carefully so they do not harm cancer patients, survivors or those at risk for cancer.

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.

 

 

Current federal requirements provide crucial protections that ensure health insurance coverage is comprehensive, not arbitrarily limited, available to all and more affordable.  These protections are especially important for cancer patients, survivors, and those at risk for cancer.  This fact sheet contains a list of the most important provisions in current law for the cancer community.

Medicaid Resources:

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.

The Children's Health Insurance Program (CHIP) is an integral part of the safety-net for lower-income children and their families. CHIP provides access to quality, affordable, and comprehensive health care coverage to nearly nine million lower income children up to age 19 in the U.S. – many of whom have been affected by cancer.

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.

A Section 1115 Demonstration Waiver gives states flexibility to design and improve upon their Medicaid programs through pilot or demonstration projects.