Although most of us could probably surmise that having health insurance increases the chances of surviving a major illness, researchers at Loyola University Chicago recently put the theory to the test. In a June 2017 study in the journal Cancer Epidemiology, researchers found that more patients were diagnosed with stage 1 breast cancer after the Affordable Care Act took effect, widening the population able to obtain health insurance. These cancers were found early when they are most treatable, thereby improving survival rates.
[See: A Tour of Mammographic Screenings During Your Life.]
The study examined patient records from more than 470,000 breast cancer patients between the ages of 50 and 74 who were covered by private insurance orMedicare and were newly diagnosed. The study compared diagnosis rates between 2007 and 2009, before the ACA went into effect, and the period between 2011 and 2013 after the ACA took effect. Researchers found that stage 1 breast cancer diagnoses increased 3.6 percentage points after the ACA went into effect, rising from 54.4 percent to 58.0 percent. This was directly correlated with a decrease in stage 2 and stage 3 diagnoses, indicating that more people were being diagnosed earlier after they were covered by the ACA. African- Americans and Latinos saw the biggest increase in early stage diagnosis, which further supports the hypothesis that previously uninsured or underinsured patients were receiving coverage that enabled them to access the care they needed.
Because the ACA eliminated copaymentsand reduced other out-of-pocket costs for 45 preventive care services, including mammograms, getting these screening services became more affordable and more patients were able to access them, the researchers report. And this in turn is likely to lead to improved breast cancer survival rates.
The Cost of Care
Being diagnosed with any serious or chronic disease is an expensive endeavor in the United States today. A 2016 study in the journal American Health & Drug Benefits reports “the costs were higher for patients whose cancer was more advanced at diagnosis,” with “the average costs per patients allowed by the insurance company in the year after diagnosis” being $60,637 for stage 0, $82,121 for stages 1 and 2, $129,387 for stage 3 cases and $134,682 for a stage 4 breast cancer diagnosis.
In essence, the earlier the disease is found, the cheaper it is to treat, but it’s still going to be expensive. Many people – especially those who do not have insurance or have inadequate health insurance – struggle to pay for thesetreatments. Any portion of the treatment not covered by insurance must be paid for by the patient, and these expenses can add up.
Jackie Weber, senior manager of practice operations at UF Health Cancer Center – Orlando Health, says that having insurance is important and a key to better outcomes when dealing with a breast cancer diagnosis. Weber, who is a breast cancer survivor herself, says, “I feel like I’m a good example of having insurance and things going well because I do have insurance. We do know even though we do our best to try to get access for screening mammograms, if a woman doesn’t have insurance she’s not likely to have the follow-up diagnostics ” she needs when something suspicious shows up on the mammogram. So for all the free screenings that various organizations offer, if those who are screened can’t pay for the next steps in care, their prognosis is grim.
In her case, Weber has just surpassed the three-year anniversary of her diagnosis with triple negative, a very aggressive form of breast cancer, that was caught early. She underwent several rounds of chemotherapy, a lumpectomyand radiation treatments. She’s currently cancer-free, and her prognosis is great because she was able to get the care she needed early on.
In other cases, however, women delay seeking care because they can’t afford it, and then will seek emergency room treatment when the issue becomes too painful or unwieldy to ignore. “Their cancer could be so advanced by then that it could be very difficult for them to fight it or survive it,” but if they’d had insurance or another means of paying for care, they could have been treated earlier when their chances of survival were better, Weber says.
“Most plans these days offer great coverage for routine care, and that’s what can detect things,” she says. But not all plans are as robust in covering follow-up diagnostics and treatments. So even though some patients will have health insurance, it may not be enough to meet their needs.
If this describes you, don’t panic. There are other resources that may be available to help you. Breastcancer.org offers a comprehensive list of potential sources of funding for breast cancer patients who need coverage. Philanthropic organizations may also be able to help. The AVON Foundation supports theCancerCare program that offers financial assistance for underserved women with breast cancer. The Susan G. Komenfoundation also lists a range of programs that can help cover aspects of treatment for some patients.
“There are many avenues to go down,” Weber says. “The American Cancer Society is the biggest, broadest umbrella.” The ACS offers financial assistance to patients who need it, and locally, Weber says many communities also have funds or grants available to patients who need help. “There are a lot of things out there, but it requires research,” she says. A member of yourcare team should be able to point you in the right direction if you’re struggling to make ends meet after a breast cancer diagnosis.
In addition to assistance paying for treatment, transportation to the hospital and other services, Weber says her team seeks to help patients by lowering the cost of treatment. “We work with drug companies all the time to lower the cost of chemo drugs. They can be phenomenal in working with us.” She says some companies also offer copay assistance programs for patients. This can be especially helpful for people who are covered by health insurance plans that offer the basics but come with hefty deductibles or large copays that can be out of reach for low-wage workers or the unemployed.
“We don’t hear a lot of good things about drug companies usually,” Weber says, “but when it comes to cancer patients, they’re very patient-focused and will try everything they can to try and cure someone and improve their quality of life.”
She says any and all of this assistance starts with the patient alerting a member of the care team to the financial burden they may be experiencing. Therefore, it’s important to talk with your doctor orpatient navigator if you’re having trouble financially. Most hospitals will work with patients to set up payment plans or to seek out other funding sources to cover the cost of treatment. But having insurance to begin with is the best option. “Patients are so much more set up for success when they have that insurance plan and that comfort and can go and get care,” Weber says. “Having insurance is a blanket of safety that gives [patients] the freedom to be able to take care of themselves and seek out care ahead of illness. If I hadn’t been able to get that mammogram with my type of cancer I don’t know that I would have survived.”