A Personal Story of Underinsured Consumers (Dan Smith)

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Access to Health Care:

The Cancer Perspective

Daniel E. Smith

President,American Cancer Society Cancer Action Network (ACS

CAN)

November 2007



Making Progress



80

90

100

110

120

130

140

150

160

170

180

190200

210

220

'75 '78 '81 '84 '87 '90 '93 '96 '99 '02 '05 '08 '10 '1

Year

Ra

Incidence and mortality rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.

SEER Cancer Statistics Review 1975-2003.

All Sites – Mortality RatesAll Sites – Mortality Rates

By Year of Death – All Races, Males and

Females

1991 Baseline

215.12004

185.7

2015 Goal – 50 Percent Reduction fromBaseline

2015 Goal107.6

( 13.7% from

Baseline)

(Current trend to 2015 - 36.8% from Baseline) (The latest

joinpoint trend (2002-2004) shows a -2.1 APC in age-adjusted

rates)

2015

Projected

Rate-135.9Ra t e



Odds of More Advanced Stage atDiagnosis, Colorectal Cancer, NCDB,1998-2004

Insurance Stage II vs. I Stage III or IVvs. I

Private 1.0 (Ref.) 1.0 (Ref.)

Uninsured 1.9* 2.0*Medicaid 1.4* 1.6*

Medicare Age 65+ 1.0 1.0

Race

Non-Hispanic White 1.0 (Ref.) 1.0 (Ref.)

Non-Hispanic Black 1.1* 1.3*

Hispanic 1.1* 1.1**Odds ratio is significant at the 95% confidence level.

Note: Model adjusted for insurance type, race/ethnicity, age at diagnosis,income, proportion without high school degree, US census region, year of

diagnosis, and facility type..Source: Halpern et al, 2007 (manuscript in preparation)



Cancer creates financial burdens

Percent who say each of the following happened to them/theirfamily member as a result of the financial cost of dealing withcancer…

6%

7%

7%

9%

10%

22%

6%

15%

35%

41%

34%

30%

46%

3%

Ever uninsuredduring illness

Always insuredduring illness

Used up all or most of savings

Borrowed money from relatives

Contacted by a collection agency

Unable to pay for basicnecessities like food, heat, or

housing

Sought the aid of charity or publicassistance

Borrowed money/got aloan/another mortgage

Declared bankruptcy

Source: USA Today/Kaiser Family Foundation/Harvard School of Public Health Cancer Survey ( conducted August 1 – September 14, 2006)



Most Important Diseases or Health Conditionsthe Government Should Address?

11%

16%

21%

41%

51%

Diabetes

Heart disease

Avian flu

HIV/AIDS

Cancer

Harvard School of Public Health and the Robert Wood Johnson Foundation,Americans’ Views of Public Health, April 2006.



Our Charge

American Cancer Society’s vision: – By 2015, everyone will have timely

access to the full range of evidence-

based health care necessary to optimizehealth and well-being.

American Cancer Society’s role: – We will help frame the debate by

bringing national attention to access tocare as seen through the cancer lens.



“What is Meaningful Insurance?”

- Policy Review Group

• Phase 1 – Principles statement andevaluative tool (2006)

• Phase 2 – Incentives for prevention in thehealth systems (March 2007)

• Phase 3 –Costs (October 2007)

• Additional research underway

Develop Policy Options Looking at the Health Care System

through the Cancer Lens



The Four A’s:

•

Adequacy• Affordability

• Availability

• Administrative Simplicity

Phase I:Principles Statement

How will we evaluate meaningful insurance



Phase I:The Evaluative Tool

• A detailed list of questions the Society will askabout any reform proposal or health care system

• May be applied to different models of health carereform or change

• Provide the basis for developing practical andmore specific evaluative criteria in the four mainareas: adequacy, availability, affordability, andadministrative simplicity

• Accessible to all volunteers and field staff

• The Society is not currently offering its own plan,but rather will evaluate proposals put forth byothers and decide whether to support them



Threshold Questions

I. Does the proposal contain the essentialcomponents: adequacy, availability,affordability, and administrative simplicity?

II. Does the reform plan reduce or eliminatesegmentation ( “cherry picking”) of the healthinsurance market?

III. Is the financing of the reform adequate tosustain it?



Frame the Issue and Educate:Health Insurance Assistance Service (HIAS)

• Began April 2005 – Georgetown Universitypartnering with ACS (NGRD and HP)

• Active in 28 states

• 17 health insurance specialists (and counting)

• More than 9,000 cases opened

• We will use these stories to show problems with thecurrent health care system through the cancer lens



Partnerships and Collaborations

One compelling message…



Is the choice between losing your lifeand losing everything really a choice?

Fighting cancer is tough enoughwithout having to fight for the helpyou need.

What kind of health care system is it if you have to beg for the opportunity to

fight cancer?

What good is a health care system if itcan’t help those who need it?

Access to Care Messaging



www.acscan.org



Access to Care Petition



•Aggressive advocacy work at the state andfederal levels to expand access

• SCHIP

• NBCCEDP

• Establish CRC pilot screening & treatmentprogram for the uninsured; and ensurecoverage for all Americans

• Fund patient navigators

•

Provide access to cessation and clinicaltrials

• Eliminate barriers to prevention in Medicare

• Preserve existing coverage

Advocacy:Current Work

A Personal Story of Underinsured Consumers (Dan Smith)

Documents

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