Cancer Care Costs Squeeze Millions of Americans

Millions of Americans with cancer struggle to pay for care, even with insurance.

Feb. 5, 2009— -- Even people who have health insurance can be bankrupted if they come down with cancer, says a new report from the American Cancer Society.

The Kaiser Family Foundation and the American Cancer Society unveiled a new joint report today that outlined the serious financial consequences families face when a member is diagnosed with cancer. In addition to dire statistics and figures, the report featured the stories of 20 patients who have faced severe debt and other challenges in their struggle to get treatment for their disease.

Some lost their life savings; others lost their jobs. Some found it nearly impossible to find insurance to help them pay for the care they needed. And some had to file for bankruptcy.

John Seffrin, the national chief executive officer of the American Cancer Society, noted during the briefing that these stories, unfortunately, are all too common.

"Two million cancer survivors today are forgoing care they need simply because that care is unavailable because they cannot afford it," Seffrin said, adding that lack of access to quality care is now a major case of cancer death in the United States.

"This issue is not only a serious public health issue; it is a moral imperative for change."

Christy Schmidt, one of the report's authors and a cancer survivor, told that the report is even more frightening considering that all of those profiled had health insurance.

"Just because you're insured doesn't mean that you're not going to have... very, very serious financial problems," she said. "The very design of insurance policy itself can cause significant expenditures, even leading to bankruptcy or loss of home for some people."

"One in five people with cancer use up all or most of their savings, and those are people who have insurance."

Losing Your Home to Cancer Costs

Anna Nunes of Lake in the Hills, Ill., is not one of the 20 patients whose story appears in the report. But she is among the millions of Americans who have suffered financial problems after recovering from cancer. She and her family lost their home in nearby Crystal Lake after she was diagnosed with and treated for breast cancer two years ago.

She was diagnosed in July 2007 and had her first surgery -- mastectomy and reconstructive surgery -- in October of that year. Despite coverage through her husband's job, she was unable to keep up with the bills.

"As much as I knew that we were probably going to lose our house... it just got to the point where there was no recovery," she said of the cost of treatment. "I just figured at this point, it's just money and it's just a house. It doesn't really matter where we live as long as we're all together and healthy."

Nunes had what she hopes is her last surgery -- for reconstruction -- last week. But she said she considers herself luckier than most cancer survivors.

"It was actually caught very early. I was lucky that I didn't have to go through any chemo or radiation."

Fortunately, Nunes' apartment, where she lives with her husband, a postal worker, and their two teenage daughters, is only half a mile from their old home, so the daughters attend the same schools. A real estate agent before cancer, Nunes still works in that field part time, also working part time in retail.

But she said the financial situation after she began receiving treatment was overwhelming.

"The medical bills didn't help. The diagnosis and not being able to work didn't help," Nunes said. "You're just at the point where you do what they say because you are devastated. ... You just don't think of that stuff when you're told something like this."

Getting Cancer Costs Under Control

Robert Zirkelbach, a spokesman for America's Health Insurance Plans, said the American Cancer Society's report exposes the need for reform.

"This report highlights the needs to get health-care costs under control," he said. "You're seeing that especially when it comes to cancer treatments. Cancer drugs are a driver in these rising costs."

Zirkelbach pointed to a report issued by his group in December that he said addressed the group's ideas for comprehensive health-care reform.

Among the group's proposals, he said, is one that addresses the concern of many that insurance will not cover pre-existing conditions. He said the new proposal would alleviate that concern, but that it would go hand in hand with people maintaining coverage, without gaps.

Zirkelbach added that his organization also advocates creating a government agency that tests treatments, comparing them to see which is the most effective, so that costly treatments do not take up unnecessary health-care dollars. This would complement the Food and Drug Administration, which simply tests that new drugs work, without considering how they compare to current treatments.

But Zirkelbach stressed that the issues in health insurance go beyond cancer care.

"A lot of these issues that this report talks about need to be addressed on a comprehensive basis, not just with regard to cancer treatment. ... The cost of treatment is only part of the financial obligations that an individual has."

Indeed, many with cancer lose their jobs. Zirkelbach cited this as a reason why individuals should consider long-term disability insurance, which would help pay bills when they are out of work because of illnesses. According to U.S. Department of Labor statistics, about 30 percent of workers in private industry -- in all, about 40 million Americans -- have employer-sponsored long-term disability insurance.

Long-term disability through private insurance can help provide some level of income for people ineligible for government programs, which require disability for a significant time. Social Security disability, which is for people who expect to be out of work temporarily but for more than a year, does not kick in until a person has been out of work because of a medical disability for at least five months. While it is rare to have delays with cancer patients, a delay in hearing time can lead to a longer waiting period for benefits. The payments, based on a complex government formula, will never be equal to job income levels.

Medicare, which is paid to people who are permanently disabled and can never return to work and covers only medical expenses, will not kick in until two years have passed since someone has started collecting Social Security disability benefits, so cancer patients who apply will not receive benefits until 29 months after their diagnosis.

Additionally, Schmidt said, the co-payments with insurance are often too high for people who need continuous treatment, the annual limits may be exceeded by some patients and sometimes the treatments are too limited for what a patient actually needs.

"I think what we want from this report is we need to understand that there needs to be adequate insurance that is affordable," she said.

Of cancer survivors, she said, "You shouldn't have to go $100,000 in debt; you shouldn't have to lose your house."

Dan Childs contributed to this report.