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 November 10, 2015, ACS CAN hosted the first National Summit on Health Equity in St. Louis, Missouri. The summit brought together over 150 innovative thinkers in public policy, business, technology, academia, patient care, community health, and patient advocacy to examine public policy solutions for assuring greater health equity for cancer patients in the evolving health care system.

These comments were submitted by ACS CAN to the U.S. Department of Health and Human Services regarding changes to the template Summary Plan Document that health insurance plans must provide to consumers.

In a letter to the National Association of Insurance Commissioners (NAIC), ACS CAN and other organziations provided specific comments to provide greater consumer protections and improvements to  the NAIC's Health Carrier Prescription Drug Benefit Model Act (Formulary Model Act). 

ACS CAN filed comments on the 2017 Notice of Benefit and Payment Parameters, including issues related to Medicare notices, standardized plan option designs, and network adequacy.

ACS CAN filed comments supporting the Internal Revenue Services' proposed clarification requiring plans to provide coverage for physician services and inpatient hospitalization in order to qualify as minimum value coverage. 

ACS CAN filed comments on the Medicare CY2016 Physician Fee Schedule, supporting CMS' proposals to establish a separate payment for collaborative care services and provide reimbursement for advanced care planning services.

This paper explores from a cancer patient’s perspective the adequacy of provider networks, the transparency of provider network information for the new qualified health plans (QHPs) offered in the Marketplace and the availability of out-of-network coverage.

ACS CAN provided comments on the proposed rule implementing changes to the Summary of Benefits and Coverage (SBC) and the Uniform Glossary in which we urged the Tri-Agencies to include a high-cost coverage example (specifically a breast cancer example) in the SBC, to require the inclusion of premium information on the first page of the SBC, and to eliminate the current coverage calculator and require plans to use actual plan data when providing coverage examples.

ACS CAN provided comments on the proposed rule implementing changes to the Medicare Shared Savings Program in which we urged CMS to provide additional beneficiary education and require greater specificity on wasy to improve care coordination for beneficiaries.

Prescription Drug Affordability Resources:

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 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.

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

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).

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.

Private Health Insurance Resources:

On March 6, 2018, ACS CAN filed comments on the proposed rule implementing changes to the Employee Retiree Income Security Act’s (ERISA’s) definition of “employer” for purposes of determining when employers may join together to form an Association Health Plan (AHP).

On April 20, 2018, ACS CAN filed comments on the proposed rule amending the definition of short-term, limited-duration (STLD) insurance for purposes of its exclusion from the definition of individual health insurance coverage.

ACS CAN Comments re: DRAFT 2019 Letter to Issuers in the Federally-facilitated Marketplaces

ACS CAN Comments on the 2019 Notice of Benefit and Payment Parameters

ACS CAN comments to Steven Mnuchin and Seema Verma on Iowa's 1332 Waiver

ACS CAN Comments on Massachusetts 1332 Waiver

ACS CAN Comments on Oregon 1332 Waiver

ACS CAN Comments on Iowa 1332 Waiver

ACS CAN submitted comments on the ACA market stabilization rule.

Costs and Barriers to Care Resources:

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.

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.

 

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.

As Congress debates enacting changes to the health care market, one concept re-emerging is state high-risk pools to provide health insurance coverage for individuals who otherwise cannot obtain or afford coverage. High risk pools are not a new concept. Prior to the enactment of the Affordable Care Act (ACA) many states operated some form of high risk pool. During implementation of the ACA, a federal high risk pool was established as an interim step to the new marketplaces. The overall success of high risk pools varied. This fact sheet examines how state risk pools work and the impact on persons with cancer and cancer survivors.

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.

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.

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.

Medicaid Resources:

ACS CAN CMS Comments on Massachusetts 1115 Demonstration Waiver

ACS CAN CMS Comments on Maine 1115 Demonstration Waiver

ACS CAN CMS First Comments on Massachusetts 1115 Demonstration Waiver

ACS CAN CMS Comments on Arkansas 1115 Demonstration Waiver

ACS CAN CMS Comments on Wisconsin 1115 Demonstration Waiver

ACS CAN, the American Heart Association, the American Diabetes Association released a joint statement providing principles for any entitlement reform proposal.

ACS CAN, the American Heart Association, the American Diabetes Association released a joint statement in support of the Medicaid program, noting that any reforms should improve the value of care provided under the program and should not reduce access for Medicaid beneficiaries.

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