Experiences of Cancer Patients Illustrate Potential Problems With Private Health Coverage For People With Life-Threatening Illnesses

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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:

• 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.

• 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.

• 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.

• 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.

• 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.

The report and video are available online at www.kff.org and www.cancer.org. In addition, a webcast of today’s briefing will be available online after 5 p.m. ET today.

The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information, research and analysis on health issues.

The American Cancer Society is dedicated to eliminating cancer as a major health problem by saving lives, diminishing suffering and preventing cancer through research, education, advocacy and service. Founded in 1913 and with national headquarters in Atlanta, Georgia, the Society has 13 regional Divisions and local offices in 3,400 communities, involving millions of volunteers across America. For more information anytime, call toll free 1-800-ACS-2345 or visit www.cancer.org.