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New Report Highlights
Health Care System’s Financial Squeeze on Cancer Patients
Experiences of Cancer Patients Illustrate Potential Problems With
Private Health Coverage
For People With Life-Threatening Illnesses
WASHINGTON, DC – Cancer patients can face severe challenges in paying
for life-saving care – running up large debts, filing for personal
bankruptcy and even delaying or forgoing potentially life-saving
treatment – even when they have private health insurance, according to a
new report by the Kaiser Family Foundation and the American Cancer
Society.
The report profiles 20 patients and illustrates the potential
difficulties people diagnosed with cancer or other serious illnesses
have in maintaining affordable health insurance and paying for their
health care. The patients in the report and accompanying video were
selected to illustrate typical cases from the many people who call the
American Cancer Society’s Health Insurance Assistance Service, which
helps families affected by cancer who encounter problems navigating the
health care system.
For these patients, having private health insurance at the time of their
cancer diagnosis did not protect them from high out-of-pocket costs –
leaving them with large debts to cover their treatment costs and forcing
some to skip or delay necessary treatments.
“The stories of people with cancer in this study and video documentary
show what our earlier survey work found: that the insurance system often
fails people when they need it most, when they get really sick,” said
Kaiser Family Foundation President and CEO Drew Altman, Ph.D.
“Cancer patients too often find out that their insurance doesn't protect
them when they need care the most,” said John R. Seffrin, Ph.D.,
national chief executive officer of the American Cancer Society. “High
out-of-pocket costs coupled with the high cost of insurance premiums can
force cancer patients to incur huge debt, and to delay or forgo
life-saving treatments.”
The report, which was released today at a briefing in Washington, D.C.,
highlights five key gaps in the health care system that can leave people
with cancer and other life-threatening diseases in financial jeopardy as
a result of their diagnosis:
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High cost-sharing, caps on benefits leave cancer patients
vulnerable.
The various types of cost-sharing and limits on benefits found in
some insurance plans may quickly lead to high out-of-pocket costs
once cancer treatment begins. For instance, Jamie Drzweicki of
Miami ran up more than $75,000 in debts after her breast-cancer
treatment costs exceeded her policy’s annual limit.
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Those with employer-sponsored coverage may not be protected from
catastrophically high health care costs if they become too sick to
work.
Most people get their health coverage through their employers, which
often pay most of the premiums. Under existing law, people who lose
their jobs because they are unable to work generally must decide
within 60 days whether to temporarily retain their
employer-sponsored coverage through COBRA by paying the full premium
costs. Phyllis Miller of Johnstown, Pa., who has been unable to work
since having emergency surgery for late-stage colon cancer, missed
the 60-day deadline and has struggled since then to afford the
premiums and cost-sharing of her less comprehensive individual
policy.
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Cancer patients and survivors are often unable to find adequate and
affordable coverage in the individual market.
Cancer survivors who have been in remission for years and have a
good long-term prognosis may still have trouble finding coverage or
pay higher premiums in the individual market. For instance, 10
years after Thomas Olszewski of Graham, Texas was treated for early
prostate cancer, he still is unable to find affordable health
coverage and pays one-fourth of his family’s income in premiums for
a high-deductible plan.
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High-risk insurance pools are not available to all cancer patients,
and some find the premiums difficult to afford.
High-risk pools, which are designed to help cancer patients and
others who are uninsurable, are not available in all states, and
when they are available, they are often much more expensive than
most other plans in the individual market. For example, high costs
have prevented breast cancer survivor Mardel Budreau of West
Lafayette, Ind. from enrolling in a high-risk pool after learning
her individual insurance policy only paid $250 toward her radiation
treatment.
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Waiting periods, strict restrictions on eligibility, or delayed
application for public programs can leave people who are too ill to
work without an affordable insurance option.
Cancer patients too sick to work may qualify for Social Security
Disability Insurance income and, after two years of receiving this
income, may qualify for Medicare coverage. During the waiting
period, patients typically have reduced incomes and may not be able
to afford private insurance coverage. This happened to David Young,
a truck driver from Godwin, N.C., who has not worked since being
diagnosed with late-stage kidney cancer. Young became eligible for
Social Security disability benefits in October 2007 but does not yet
qualify for Medicare benefits.
The report, Spending to Survive: Cancer Patients Confront Holes in
the Health Insurance System, was jointly authored by researchers at
the Kaiser Family Foundation and the American Cancer Society. The
Kaiser Family Foundation also released a separate video documentary
profiling three of patients featured in the report.
February, 2009
The report and video are available online at
www.kff.org and
www.cancer.org. |
COST OF CANCER