Robbinsdale Resident Addresses Cancer Care Costs in Congressional Briefing

Speakers discuss how the current policy landscape will affect cancer patients and survivors

November 9, 2020

Robbinsdale, MN – The American Cancer Society Cancer Action Network (ACS CAN) hosted a virtual Congressional briefing today featuring policy and advocacy experts that addressed details in ACS CAN’s newly released report, “The Costs of Cancer: 2020 Edition.” The briefing comes just one day before the U.S. Supreme Court hears oral arguments in California v. Texas to evaluate the constitutionality of the health care law, a law that contains numerous patient protections the have improved access to affordable, quality health care for those with pre-existing conditions including cancer. Speakers discussed the potential impact of the outcome of the case could influence health care cost and insurance coverage in the United States, as well as what Congress can do to ensure cancer patients have access to quality and affordable care.

“Research shows us that in order to address the high costs of cancer, the single most important thing policymakers can do is ensure everyone has access to quality, comprehensive health insurance coverage,” said Lisa Lacasse, president of ACS CAN, in her opening remarks.

“Cancer is hard, really hard. The financial toxicity makes it even more difficult. I’m hopeful that together we can make some changes to alleviate some of this burden so patients can focus on their care and their loved ones as they navigate cancer treatment; and certainly not take away our insurance coverage which literally keeps us alive,” said Monica Theis, one of the panelists and a four-time cancer survivor from Robbinsdale, Minnesota.

Theis leads the Ambassador Constituent Team (ACT!) for ACS CAN, serving as the primary volunteer contact with Congressional District 5 lawmakers. Others in the Congressional briefing panel included Dr. Kavita Patel, nonresident fellow at USC-Brookings Schaeffer Initiative for Health Policy; Jennifer Hoque, senior policy analyst for ACS CAN; and Keysha Brooks-Coley, ACS CAN’s vice president of federal advocacy and strategic alliances.

The Costs of Cancer report—released just a few weeks before the Supreme Court hears a case that could invalidate the Affordable Care Act (ACA) and significantly alter how Americans get health care and what they pay for it—found a wide range in total patient costs, especially between the ACA-compliant plans and the non-compliant non-comprehensive short-term limited duration (STLD) plan. When premiums, deductibles, co-pays and co-insurance were calculated, patients with comprehensive or ACA-complaint coverage paid between $5,000 out-of-pocket in a large employer plan to over $12,000 in an individual marketplace plan for their care. However, the patient costs in an STLD plan totaled a staggering $52,000, due largely to the fact the plan did not cover prescription drugs and has a deductible of over $12,000. STLD plans, which have proliferated under an administrative rule change, are not required to cover essential health benefits, including prescription medication, and do not have to cap patient expenses.

Key report findings include:

  • Having insurance coverage and the type of coverage is critical. Benefit design determines how much a patient pays and how and when they’ll pay it. High deductible health plans may have lower monthly premiums, but force patients to pay much higher costs all at once when they get sick, which can be challenging for patients and may lead to delayed tests or treatment.
  • Out-of-pocket limits protect cancer patients, who rely heavily on their insurance benefits to treat their disease. Such patients often hit their maximum spend quickly and once reached do not have to pay cost sharing for in-network covered services.
  • STLD plans put patients at risk for extreme costs as they do not have to cap patient out-of-pocket spending, can have even higher deductibles, and do not have to cover specific essential services.

Other findings include that changing insurance plans mid-year can cause spending spikes and higher total costs—a scenario more people may be experiencing due to coronavirus-related layoffs—and that the type of cancer, treatment plan, and treatment duration can cause huge variation in how much patients pay. The patient profiles do not account for out-of-network services, surprise medical bills, transportation and other expenses patients often incur.

Cancer is one of the leading causes of death and disease in the United States. Nearly 1.8 million Americans are expected to be diagnosed this year. In Minnesota, an estimated 33,210 people will be diagnosed with cancer and approximately 10,000 will die from this disease this year.