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.

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.  

Pharmacy benefit managers (PBMs) are entities that administer prescription drug programs for many private, public, and employer health insurance plans. PBMs establish pharmacy networks, negotiate prices with pharmaceutical manufacturers on behalf of their clients, and provide basic claims administration.

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.

Prescription drugs are often less expensive in other countries. This is due to a variety of factors. There have been efforts at the state and federal level to allow individuals to purchase lower cost prescription drugs from other countries and import these products into the United States for personal use.

New breakthroughs in cancer research are making more life-saving drug therapies available. Keeping these therapies affordable for patients is imperative. Prohibitive cost sharing for prescription drugs can cause patients to skip dosages, split pills or stop taking their medications entirely, which reduces the effectiveness of their treatment.

Currently, Medicare part D is administered entirely by private plans that follow guidelines set by CMS. Policymakers propose allowing the Secretary of Health and Human Services to enter negotiations between pharmaceutical manufacturers and Part D plans in an attempt to lower prescription drug prices.

Most health insurance plans that cover prescription drugs use formularies to categorize the drugs the plan will cover and determine the amount of patient cost sharing. Divided into “tiers”, the higher the tier, the higher the share of cost for patients.

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.

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.

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 prem

ACS CAN provided comments on CMS' Draft 2016 Letter to Issuers in the Federally-facilitated Marketplaces, including comments related to network adequacy, provider directories, nondiscrimination provisions, and other issues.

ACS CAN filed comments on the 2016 Notice of Benefit and Payment Parameters proposed rule, including comments related to Special Enrollment Periods, prescription drug benefits, nondiscrimination, cost-sharing requirements, network adequacy standards, and other issues.

As the National Association of Insurance Commissioners (NAIC) updated its Managed care Plan Network Adequacy Model Act (Network Adequacy Model Act), ACS CAN filed comments urging the NAIC to adopt policies that would ensure that health plan networks  are sufficient to provide enrollees with acces

In this 2014 white paper, ACS CAN explored, from a cancer patient's perspective, the adequacy of provider networks, the transparency of provider network information for new qualified health plans offered in the Marketplace, and the availability of out-of-network coverage.

Medicare Resources:

This Chartbook provides an overview of cancer among the elderly.

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Health Care Delivery Resources:

A comprehensive plan to address all barriers is necessary to make prevention a national priority.

Adequate and sustained investments and improvements in the prevention and early detection of disease are essential to refocusing the health care system on wellness.

Adequate and sustained investments and improvements in prevention and early detection are essential to meaningful health care reform. The Affordable Care Act took an important step in addressing these issues by creating a mandatory fund, known as the Prevention and Public Health Fund, to provide an expanded and sustained national investment in evidence-based programs that will help improve health and reduce chronic disease in our nation. 

Medicaid coverage of preventive services is essential to improving the long-term health and well-being of our nation’s most vulnerable populations. 

Ensuring access to evidenced-based cancer screenings and quality treatment is critical to the fight against colorectal cancer. 

In this 2011 paper, ACS CAN commissioned the George Washington University Department of Health Policy to explore a range of questions related to the quality of cancer care and health care delivery in the United States in order to gain better insights into some of the barriers to receiving quality

Our nation’s health care system is one of the most expensive in the world. Yet the quality of care we deliver to our citizens continues to lag behind that of other industrialized nations. 

Currently, Medicare beneficiaries with a chronic disease such as cancer often receive health care services from multiple physicians and specialists who rarely coordinate care.

Approximately 160 provisions in the final health care legislation will directly impact the millions of Americans who have or will face cancer. The following is a list of the most important provisions for the cancer community:

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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.

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

ACS CAN submitted comments on the proposed Medicaid and Children's Health Insurance Plan Managed Care rule.

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.