Before the the Policy Summit on November 17-18 I thought that it was too early to move forward on expanding coverage and access. I thought that the next two years of gridlock in Washington would lead to frustration among advocates.
After two days of meetings my thinking has changed. It may be the right time to start to move forward on building a multi-partisan coalition on those aspects of reform for which there is broad consensus. There may not be agreement on everything, but in any political process there is always some uncertainity as to what the exact outcome will be.
One area where there seems to be consensus is that coverage and access for children is a high priority. The State Child Health Isurance Program (SCHIP) - known as KidsCare in Arizona - enjoys support from both parties.
There are other groups of patients that also have wide recognition as being in need of support. One of those groups is that of families affect by cancer. I received an email rom the Kaiser Famly Fondation today announcing a major survey:
A major national survey of people affected by cancer provides an in-depth examination of how families cope with cancer and highlights problems of health insurance and health care costs through the lens of those who have experienced this major illness. The results show how health care and health insurance systems can fail to protect people when they are most in need.
Conducted jointly by USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health, the survey shows the disease’s devastating impact often extends beyond an individual patient to affect entire families – sometimes causing financial crises, strained relationships, and physical and mental health issues for those who love and care for people diagnosed with cancer.
The survey found that one in four families affected by cancer say the experience led the person with the disease to use up all or most of their savings, and one in eight say they borrowed money from relatives. The illness also made it harder for some to find and keep health insurance – with about one in 10 saying they couldn’t buy health insurance because they had been diagnosed with cancer, and 6% saying they lost their coverage as a result of the disease.
Having health insurance at all times during treatment helped to limit the financial consequences of a cancer diagnosis, but even those with consistent coverage faced difficulties – one in five used up all or most of their savings, one in 10 borrowed money from relatives and 9% were contacted by a collection agency.
Among those who did not have health insurance consistently during their illness, the financial burden was even greater. More than one in four said that they delayed or decided not to get treatment because of its cost – five times the rate reported by those who had health insurance consistently. Nearly half used all or most of their savings; four in 10 were unable to pay for basic necessities; one in three sought the aid of a charity or public assistance program; and 6% filed for personal bankruptcy.
Many years ago Medicare was expanded to cover end-stage renal disease for all patients. While many of us might dislike the idea of expanding Medicare to cover the costs of cancer care in excess of $25,000, such a proposal would:
(1) reduce the costs of employer-provided health insurance, by reducing the impact of cancer on their programs, making it easier for employers to continue to offer coverage or making it possible to offer it for the first time;
(2) reduce the costs of Medicaid programs, transferring catastophic cases from state programs to a national program, where the Federal government can more effectively negotiate contracts with the producers of the very expensive biotechnology products and selectively contract with national centers of excellence.
(3) reduce the burden on those who are in high-deductible health plans with health savings accounts but do not have sufficient reserves in their HSAs during the transition period to that model of health care financing.
(4) provide some coverage to the uninsured middle income families who now have to exhaust their entire savings to qualify for Medicaid.