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:

In a recent poll, 51% of cancer patients and survivors report incurring medical debt as a result of their cancer care.

Patients and Caregivers for Paid Leave factsheet regarding a national paid family and medical leave program

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.

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.

Prescription Drug Affordability Resources:

Prescription drug costs are a significant burden on cancer patients and survivors, sometimes even leading patients to miss or delay taking prescribed medications. The latest Survivor Views survey explores the role copay assistance programs can play in reducing this burden, and also addresses patient navigation and digital therapeutics.

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.

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 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

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:

ACS CAN submitted comments to HHS in support of Alaska's application for an extension of its 1332 waiver establishing a reinsurance program. These programs lower premiums and increase enrollment in the private insurance market.

ACS CAN submitted comments regarding marketplace insurance plans and requirements for plan year 2023. 

ACS CAN supports the extension of Colorado's section 1332 reinsurance waiver.

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.

Medicare Resources:

ACS CAN supports CMS’ decision to delay implementation of the RO Model.

ACS CAN's comments in response to the calendar year (CY) 2022 Medicare Physician Fee Schedule proposed rule focused on two issues:

1. whether HHS should create a separate code for pain management activities, and

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

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.

Reducing Health Disparities Resources:

Cancer biomarker testing can lead to targeted therapy which can improve survival and quality of life by connecting patients to the most beneficial treatment for their disease.

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.

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

Costs and Barriers to Care Resources:

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.

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.

 

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.

Medicaid Resources:

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.

An estimated 2.2 million low-income adults who would benefit from Medicaid if their state expanded coverage are now in the “coverage gap,” uninsured and unable to qualify for affordable health insurance. Congress must extend quality, affordable coverage to people who need it by closing the Medicaid coverage gap. 

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

ACS CAN comments supporting Medicaid expansion in Oklahoma, but opposing their proposal to rescind retroactive eligibility

ACS CAN comments on Georgia's 1115 Demonstration Waiver.

ACS CAN comments on Nebraska's 1115 Demonstration Waiver.