Affordable Health Care for Individuals with Cancer
Cancer is the second leading cause of death in the United States as of 2020, after heart disease. It is projected that there will be approximately 1.9 million new cancer diagnoses and over 600,000 cancer deaths this year. The overall age-adjusted cancer mortality rate has been declining over the last 30 years, largely due to successful public health campaigns that reduced the smoking rate, greater availability of more effective treatment options, and an increase in prevention and early detection efforts.
President Biden’s Cancer Moonshot aims to cut the age-adjusted death rate from cancer by at least 50 percent over the next 25 years and to improve the experience of people and their families living with and surviving cancer. Achieving this goal requires actions to expand health coverage and treatment affordability. This blog discusses three significant ways in which recently-enacted laws expand health coverage and affordability for Americans, including many individuals with cancer. Together, these measures will save lives by improving health care access and affordability for people with serious illnesses and by reducing barriers to preventive care.
Expanding access to affordable health coverage
Expanding health coverage allows more Americans to receive preventive cancer screenings, thus catching cancer early when its spread throughout the body is still limited and the available treatments are more effective at increasing survival probability and improving quality of life. Making health coverage more affordable also contributes to closing inequalities in access to cancer detection and treatment. Accessing early cancer detection services is particularly important, as many people postponed getting screened during the COVID-19 pandemic.
A recent survey finds that about one-third of adults with health insurance worry about affording their monthly premiums, and the most commonly reported reason for lack of health coverage is the scarcity of affordable options. The American Rescue Plan (ARP) provided additional subsidies for individuals obtaining health coverage through the ACA marketplaces, increasing the number of individuals obtaining coverage without any cost to them. This led to a record 14.5 million people signing up for ACA marketplace plans, and most people paid less for coverage than before. The Inflation Reduction Act (IRA) preserves these health coverage gains by extending the additional premium subsidies through 2025.
Individuals with high disease burdens often face high health care costs, even when they are insured. CEA estimates suggest that extension of the ACA enhanced premium subsidies means that up to 560,000 nonelderly individuals with cancer living in the United States will continue to save on health insurance premiums (Figure 1). On average, people save about $800 per year on health insurance premiums due to the enhanced subsidies. These extra subsidies will also allow up to 3 million Americans to keep their health insurance coverage, thus retaining access to crucial preventive care services and treatments if they are diagnosed with cancer.
Reducing prescription drug costs for Medicare beneficiaries
Affordability is of particular concern to individuals living with cancer, as life-saving anticancer medications are among the most expensive drugs for Medicare beneficiaries. As a result, individuals with cancer pay more out of pocket for prescription drugs (Figure 2).
Health insurance allows individuals to lower their financial risk in the event that they are diagnosed with a serious health condition, such as cancer, by pooling risk with others. Currently, individuals covered by a Medicare Part D prescription plan can face unlimited out-of-pocket costs for drugs.
The IRA makes historic changes to reduce the costs of prescription drugs for Medicare beneficiaries. For the first time, there will be an annual cap of $2,000 in Part D out-of-pocket prescription drug spending for Medicare beneficiaries. Capping the amount Medicare beneficiaries pay will lead to greater and more equitable access to valuable prescription medications which may reduce health care utilization and spending in the long run.
One analysis suggests that in 2019, Medicare Part D beneficiaries who needed to take the anticancer drug Revlimid could save over $12,000 in out-of-pocket spending on just this one drug. Other examples from this analysis indicate that beneficiaries paid an expected annual out-of-pocket cost of over $8,000 for Zytiga (used for prostate cancer care) and over $16,000 for Idhifa (used for leukemia care) (Figure 3). The out-of-pocket cap allows beneficiaries needing these drugs to save about $6,000 and $14,000 per year, respectively.
CEA calculations suggest that over 449,000 current Medicare enrollees with a prior cancer diagnosis would save an average of nearly $1,600 per year on prescription drugs because of the out-of-pocket cap (Figure 4). Medicare beneficiaries who take anticancer drugs and have out-of-pocket costs exceeding $2,000 (approximately 73,000 people) would save an average of approximately $2,700. These estimates likely understate the savings as there are many more beneficiaries who are prescribed expensive drugs who do not fill their prescriptions due to high costs. One recent study finds that up to 30 percent of Medicare beneficiaries without subsidies do not fill their anticancer drug prescriptions, likely due to cost constraints (Figure 5). With the new cap in place, additional Medicare beneficiaries who are currently foregoing filling their prescriptions may be able to fill their prescriptions. Since providers’ choice of treatment, in part, depends on their assessment of a patient’s ability to afford a given treatment, there are possibly Medicare beneficiaries who were not even prescribed some drugs because their provider did not think they could afford such prescriptions. Lower out-of-pocket costs may, therefore, improve equitable access to prescription drugs for patients with Medicare.
The cap will also protect seniors who are not currently impacted by cancer, but who might be diagnosed with the condition in the future. The probability of a cancer diagnosis increases substantially with age. Approximately 2 percent of individuals 65 years or older are newly diagnosed with cancer each year. Of the nearly 50 million Medicare beneficiaries with a Part D drug plan, approximately 1 million seniors will likely receive a new cancer diagnosis every year. The out-of-pocket cap will protect these individuals’ access to life-saving drugs, remove financial worry for seniors, and allow Americans to age with dignity.
Expanding health coverage and disability benefits to veterans
While serving the United States, many veterans are exposed to potentially toxic and hazardous substances. Some toxic-exposed veterans have developed serious health conditions, such as cancer years after initial exposure. The Honoring our Promise to Address Comprehensive Toxics (PACT) Act expands eligibility for health coverage and disability benefits to veterans and their survivors exposed to toxic substances while serving our country.
An estimated 5 million veterans who conducted certain military operations or served in certain overseas locations presumed to have toxic exposure will now be eligible to enroll in VA health care and receive hospital care, medical services, and nursing home care for any illness. Expanding eligibility for health care will allow veterans greater access to preventive care such as cancer screenings, as well as access to treatment options–aiding veterans who might develop illnesses in the future. Veterans who served in locations where presumed toxic exposures occurred and then developed one of the 23 presumed service-connected health conditions can more easily receive disability benefits. Many of these 23 health conditions are forms of cancer such as lymphoma, kidney cancer, and brain cancer. By defining these conditions presumptive for service connection, veterans with these conditions will gain access to health care and financial support more quickly.
These three recent actions will expand access to affordable high-quality health care by reducing the costs for those most in need. These investments in the health of the American people may lead to increases in productivity and economic growth by ensuring that people live longer, healthier, and more productive lives.
The Cancer Moonshot is poised to accelerate and improve the ways we prevent, treat, and detect all cancers. More individuals who currently live with cancer or who will be diagnosed in the future will benefit from new medical advances. And, the expanded access to health coverage and improved affordability of treatments will result in reduced disparities in cancer outcomes.