Patient protections such as out-of-pocket limits, currently a feature of the ACA, also play an important role in keeping health care costs down for cancer patients. (Photo: Shutterstock)
Patients are paying high costs for cancer treatment in the US, and those costs are expected to rise, a new report said. The report from the American Cancer Society's Cancer Action Network (ACS CAN) predicted that 1.8 million new cases of cancer will be diagnosed in the U.S. in 2020 and found that nearly 17 million Americans living today have a cancer history.
The report also predicts a 34% in increase cancer-related costs by 2030 from 2015 costs, which were $183 billion annually. Those costs will rise to $245.6 billion in ten years. In 2020, $200.7 billion will be spent on US cancer costs.
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The report comes at a time when the health care system is under threat of serious disruption. In addition to the chaos and uncertainty created by the COVID-19 pandemic, the confirmation of Amy Coney Barrett to the US Supreme Court on Oct. 26 has many in the health care industry worried that the Affordable Care Act (ACA) could be overturned in the near future. The ACA extended health insurance to millions more Americans when it was enacted, and its patient protections, such as ending pre-existing condition exclusions, were especially important to those with diseases such as cancer. A challenge to the constitutionality of the law will be heard in November by the Supreme Court.
According to Lisa Lacasse, president of ACS CAN, said the report underscores the importance of having affordable health care, and she urged lawmakers to protect the current health care law.
"This report shows just how important it is that patients have access to affordable, comprehensive health coverage," Lacasse said. "Research shows that paying five or ten thousand dollars out of pocket – often within a span of only 1-3 months – is extremely challenging even under the best-case scenario. Should the Supreme Court invalidate the health care law and eliminate its patient protections that mitigate these costs, millions more Americans are likely to find a cancer diagnosis to be financially devastating."
Unaffordable costs
Even with the ACA, cancer patients are shouldering significant, sometimes unsustainable, health care cost burdens, the report found. In the US, cancer patients in 2018 paid $5.6 billion out of pocket for cancer treatments, the report said.
And these costs are not borne equally by all Americans who have cancer. Younger people, people of color, Americans with lower levels of education, and lower-income patients tend to report experiencing financial hardship at higher rates when dealing with cancer. Cost can vary significantly based on type of cancer, treatment plan, and geographic location, the study noted.
Surprise medical billing, which has drawn the attention of lawmakers in recent years, is also a problem when it comes to cancer-related costs. These bills occur when a patient is being treated by out-of-network providers, even though they may think their care is in-network. The ACS CAN report found that 24% of respondents to its survey said that had received a surprise medical bill. Of those bills, 28% cost $2,000 or more.
Type of insurance makes a big difference
The report said that although treatment costs are significantly lower for those with insurance, the type of plan can make a big difference. Patients with large employer plans pay the lowest out-of-pocket costs, with relatively more-affordable premiums. Other patients, such as those with small-employer plans, high deductible health plans, or those on ACA individual marketplace plans, have higher deductibles, higher maximums for out-of- pocket costs, and pay more overall. Medicare and Medigap plans may charge substantially more in premiums but have lower copays and co-insurance costs.
The report notes that patient protections, currently a feature of the ACA, also play an important role in keeping health care costs down for cancer patients. The ACA's out-of-pocket limits are one such protection.
"Cancer patients are super-utilizers of their insurance benefits, and each patient in the scenarios who had an out-of-pocket limit reached their maximum quickly," the report said. "Once the maximum is reached, patients do not have to pay cost-sharing for in-network, covered services. This is an important protection for many privately-insured patients."
The report noted one new type of plan, the short-term, limited duration plan (STLDP) has significantly higher costs for some cancer patients. The STLDP model was expanded by rule changes during the Trump Administration; supporters said the considerably lower premium costs of STLDPs after the rule change made it an attractive alternative to ACA marketplace plans. With the rule change, the STLP model is exempt from some of the patient-protection requirements of the ACA.
But in a case study the report reviewed, a cancer patient with lymphoma found that this model becomes extremely expensive for those with serious health issues such as cancer. Where this patient could have paid from approximately $6,000 to $12,000 in out-of-pocket costs for his care under ACA-compliant plans, he was responsible for nearly $52,000 in out-of-pocket costs for his cancer care with the STLDP plan.
A call for protecting the ACA
The report ends with a discussion of what can be done to protect cancer patients from high care costs. The ACS CAN report listed priorities such as ending surprise medical billing practices, expanding subsidies for patients with ACA plans, enacting caps on out-of-patient costs in Medicare plans, and creating new insurance strategies for easing the financial burden for Americans with cancer.
The report also made a case for protecting the ACA, saying that the law has improved care for cancer patients and made that care more affordable. It said there is some evidence that ACA coverage leads to earlier diagnoses of cancer among patients.
"For all these reasons, ACS CAN strongly supports the continuation of the patient protections in the ACA," the report said. "We strongly oppose any efforts to dismantle the legislation without replacing these protections, including the current efforts to invalidate the ACA through the California v. Texas litigation, currently pending at publication of this report and awaiting hearing from the Supreme Court of the United States."
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