Even with Obamacare, childhood cancer survivors may face high costs

(Reuters Health) - Even though the Affordable Care Act (ACA) has helped more childhood cancer survivors obtain health insurance, these patients may still face higher out-of-pocket costs than other people, a recent study suggests.

More than 375,000 adults in the U.S. are survivors of childhood cancers, and their ranks are swelling as treatment advances make more of these tumors a chronic illness rather than a death sentence, researchers note in JAMA Internal Medicine.

Researchers examined data on insurance coverage and access to care one year after the enactment of the ACA, also known as Obamacare, for 698 childhood cancer survivors and 210 of their siblings who didn’t experience malignancies as kids.

Overall, about 10 percent of survivors and 8 percent of their siblings were uninsured, the study found. But survivors reported higher annual average out-of-pocket costs: $2,362 versus $1,568 for their siblings.

Annual out-of-pocket costs were also higher on average for survivors with insurance: $2,487 versus $1,293 without benefits.

“I think there could be many reasons for these findings,” said lead study author Elyse Park, a researcher at Harvard Medical School and the Massachusetts General Hospital Cancer Survivorship Program in Boston.

“It is possible that survivors simply are accessing more care; it is also possible that survivors’ premiums are higher; or that the care survivors access is less likely to be covered by their plans,” Park said by email.

Survivors had lower rates of employer-sponsored health insurance, higher rates of coverage through Medicaid, greater difficulty obtaining coverage and higher rates of being denied coverage, the study found.

However, just 14.9 percent of survivors and 11.5 percent of siblings rated their health insurance coverage as fair to poor.

Survivors were 84 percent more likely than siblings to borrow money because of medical expenses. They were also 80 percent more likely to worry about being unable to pay for a needed treatment and 74 percent more likely to worry they wouldn’t be able to afford to fill a prescription.

Compared to insured survivors, survivors without benefits were more than three times as likely to borrow money because of medical expenses.

Uninsured survivors were also more than six times as likely to worry about being unable to pay medical bills, 12 times more likely to report lacking a primary care provider, and more than eight times as likely to postpone preventive care or skip a needed medical test or follow-up appointment.

Without insurance, survivors were also more than three times as likely to skip filling a prescription, the study also found.

One limitation of the study is that it looked at access and costs at a single point in time, the authors note.

Even so, the findings add to the evidence that cancer survivors and other people with serious health problems can face higher bills and cost-related problems with access to care, said Echo Warner, a researcher at the University of Utah College of Nursing in Salt Lake City who wasn’t involved in the study.

“Given their higher risk for health problems even decades after their cancer diagnosis, it seems unlikely that survivors would experience similar out-of-pocket costs compared to healthy individuals who also had ‘bare-bones’ or no insurance and limited income,” Warner said by email.

“I suspect that individuals who were diagnosed with other severe illnesses as children may demonstrate similar out of pocket costs to childhood cancer survivors,” Warner added. “This study really underscores the importance of childhood cancer survivors obtaining health insurance to help manage the costs of their necessary healthcare, and emphasizes the immediate need for healthcare policy, like the ACA, that continues to protect the most vulnerable patients, including survivors of childhood cancer.”

SOURCE: JAMA Internal Medicine, online September 25, 2017.