Affordable health care for people with cancer

Cancer is the second leading cause of death in the United States by 2020, after heart disease. This year, there are projected to be approximately 1.9 million new cancer diagnoses and over 600,000 cancer deaths. Overall age-adjusted cancer mortality has declined over the past 30 years, largely due to successful public health campaigns that have reduced smoking rates, greater availability of more effective treatment options, and increased efforts at prevention and early discovery.

President Biden’s Cancer Moonshot aims to reduce age-adjusted cancer mortality by at least 50 percent over the next 25 years and improve the experience of people and their families living with and surviving cancer. Achieving this goal requires action to expand health coverage and access to treatment. This blog discusses three important ways recently passed laws are expanding health coverage and affordability for Americans, including many people with cancer. Together, these measures will save lives by improving access to and affordability of health care for people with serious illnesses and by reducing barriers to preventive care.

Expanding access to affordable health coverage

Expanding health coverage allows more Americans to receive preventive cancer screenings, thereby catching cancer early, when its spread throughout the body is still limited and available treatments are more effective in increasing the likelihood of survival and improving quality of life. life. Improving health coverage also contributes to eliminating inequalities in access to cancer detection and treatment. Access to early cancer detection services is particularly important as many people have postponed screening during the COVID-19 pandemic.

A recent study found that about one-third of adults with health insurance are worried about affording their monthly premiums, and the most commonly reported reason for not having health coverage is a lack of affordable options. The American Rescue Plan (ARP) provided additional subsidies to individuals who obtain health coverage through the ACA marketplaces, increasing the number of people who obtain coverage at no cost to them. That led to a record 14.5 million people signing up for ACA marketplace plans, and most people paying less for coverage than before. The Inflation Reduction Act (IRA) preserves these health coverage gains by extending additional premium subsidies through 2025.

Individuals with a high disease burden often face high health care costs even when insured. CEA estimates suggest that the expansion of the ACA’s Enhanced Premium Subsidy means that up to 560,000 non-elderly people with cancer living in the United States will continue to save on health insurance premiums (Figure 1). On average, people save about $800 a year on health insurance premiums because of the increased subsidies. These additional subsidies will also allow up to 3 million Americans to keep their health insurance coverage, thus maintaining access to important preventive care and treatment services if they are diagnosed with cancer.

Reducing prescription drug costs for Medicare beneficiaries

Affordability is especially important for people living with cancer because life-saving cancer drugs are among the most expensive drugs for Medicare beneficiaries. As a result, people with cancer pay more out-of-pocket for prescription drugs (Figure 2).

Health insurance allows people to reduce their financial risk in the event they are diagnosed with a serious health condition, such as cancer, by pooling the risk with others. Currently, individuals covered by a Medicare Part D prescription plan may face unlimited out-of-pocket drug costs.

The IRA makes historic changes to lower prescription drug costs for Medicare beneficiaries. For the first time, there will be a $2,000 annual cap on Part D out-of-pocket prescription drug costs for Medicare beneficiaries. Limiting the amount Medicare beneficiaries pay would lead to greater and fairer access to valuable prescription drugs, which could reduce health care utilization and costs in the long run.

One analysis suggests that in 2019, Medicare Part D beneficiaries who had to take the cancer drug Revlimid could save more than $12,000 out of pocket for that drug alone. Other examples from this analysis show that beneficiaries paid estimated annual out-of-pocket costs of more than $8,000 for Zytiga (used to treat prostate cancer) and more than $16,000 for Idhifa (used to treat leukemia) (Figure 3). The out-of-pocket ceiling allows beneficiaries who need these drugs to save about $6,000 and $14,000 a year, respectively.

CEA estimates suggest that more than 449,000 current Medicare enrollees with a previous cancer diagnosis will save an average of nearly $1,600 per year on prescription drugs because of the out-of-pocket limit (Figure 4). Medicare beneficiaries who take cancer drugs and have out-of-pocket costs of more than $2,000 (approximately 73,000 people) would save an average of about $2,700. These estimates likely underestimate the savings because there are many more beneficiaries prescribed expensive drugs who do not fill their prescriptions due to high costs. A recent study found that up to 30 percent of unsubsidized Medicare beneficiaries do not fill their cancer drug prescriptions, possibly due to cost constraints (Figure 5). With the new cap in place, additional Medicare beneficiaries who currently refuse to fill their prescriptions may be able to fill their prescriptions. Because providers’ treatment choices depend in part on their assessment of a patient’s ability to afford a treatment, there are likely Medicare beneficiaries who were not even prescribed certain drugs because their provider did not think they could afford them such recipes. Therefore, lower out-of-pocket costs can improve equitable access to prescription drugs for Medicare patients.

The cap will also protect older people who are not currently affected by cancer but who may be diagnosed with the disease in the future. The likelihood of being diagnosed with cancer increases significantly with age. Approximately 2 percent of people age 65 or older are newly diagnosed with cancer each year. Of the nearly 50 million Medicare beneficiaries with a Part D drug plan, approximately 1 million seniors are likely to receive a new cancer diagnosis each year. The out-of-pocket limit will protect these people’s access to life-saving drugs, eliminate financial worries for seniors, and allow Americans to age with dignity.

Expanding health coverage and disability benefits for veterans

While serving the United States, many veterans are exposed to potentially toxic and hazardous substances. Some veterans exposed to the toxicity have developed serious health problems, such as cancer, years after initial exposure. The Honoring our Promise to Address Comprehensive Toxics (PACT) Act expands eligibility for health coverage and disability benefits to veterans and their survivors exposed to toxic substances while serving our country.

Approximately 5 million veterans who conducted certain military operations or served in certain overseas locations suspected of having toxic exposures will now be eligible to enroll in VA health care and receive hospital care, medical services and nursing home care for any illness. Expanding health care eligibility will allow veterans greater access to preventive care, such as cancer screenings, as well as access to treatment options — helping veterans who may develop diseases in the future. Veterans who served in places where there were suspected toxic exposures and then developed one of 23 suspected service-related health conditions can more easily receive disability benefits. Many of these 23 health conditions are forms of cancer such as lymphoma, kidney cancer, and brain cancer. By designating these presumptive conditions for service connection, veterans with these conditions will gain faster access to health care and financial support.


These three recent actions will expand access to affordable, high-quality health care by lowering costs for those most in need. These investments in the health of the American people can lead to increased productivity and economic growth, ensuring that people live longer, healthier and more productive lives.

Cancer Moonshot is poised to accelerate and improve the ways we prevent, treat and detect all types of cancer. More people who are currently living with cancer or who will be diagnosed in the future will benefit from new medical advances. Both expanded access to health coverage and improved affordability of treatments will reduce disparities in cancer outcomes.

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