Access to Health Care:

The Cancer Perspective

Daniel E. Smith

President,
American Cancer Society Cancer Action Network (ACS
CAN)

November 2007
Making Progress
All Sites – Mortality Rates
By Year of Death – All Races, Males and
2015 Goal – 50 Percent ReductionFemales
from
Baseline
1991 Baseline
215.1 ( 13.7% from 2004
220
Baseline) 185.7
210
200
190
180
2015
Rate

170 Projected
Rate

160 (Current trend to 2015 -  36.8% from Baseline) (The latest Rate-135.9
150 joinpoint trend (2002-2004) shows a -2.1 APC in age-adjusted
140 rates)
130
120 2015 Goal
110 107.6
100
90 Incidence and mortality rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population.
80 SEER Cancer Statistics Review 1975-2003.

'75 '78 '81 '84 '87 '90 '93 '96 '99 '02 '05 '08 '10 '13
Year
 Odds of More Advanced Stage at
Diagnosis,
Breast Cancer, NCDB, 1998-2004

Insurance Stage II vs. I Stage III or IV

vs. I
Private 1.0 (Ref.) 1.0 (Ref.)
Uninsured 1.5* 2.9*
Medicaid 1.5* 2.7*
Medicare Age 65+ 1.0 1.2*
Race
Non-Hispanic White 1.0 (Ref.) 1.0 (Ref.)

Non-Hispanic Black 1.5* 1.9*

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

Hispanic 1.3*
Note: Model adjusted for insurance type, race/ethnicity, age at diagnosis,
1.3*
income, proportion without high school degree, US census region, year of
diagnosis, and facility type.
Source: Halpern et al, 2007 (manuscript in preparation)
 Odds of More Advanced Stage at
Diagnosis, Colorectal Cancer, NCDB,
1998-2004

Insurance Stage II vs. I Stage III or IV

vs. 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*

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

Hispanic
Note: Model adjusted for insurance type, 1.1*
race/ethnicity, age at diagnosis, 1.1*
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/their

family member as a result of the financial cost of dealing with
cancer…
46%
Used up all or most of savings 22%

30%
Borrowed money from relatives 10%

34%
9%
Contacted by a collection agency Ever uninsured
41% during illness
Unable to pay for basic 7% Always insured
necessities like food, heat, or during illness
35%
housing 7%
Sought the aid of charity or public
assistance 15%
6%
Borrowed money/got a
loan/another mortgage 6%
3%

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 Conditions
the Government Should Address?

Cancer 51%

HIV/AIDS 41%

Avian flu 21%

Heart disease 16%

Diabetes 11%

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 optimize
health and well-being.
American Cancer Society’s role:
– We will help frame the debate by
bringing national attention to access to
care as seen through the cancer lens.
Develop Policy Options
Looking at the Health Care System
through the Cancer Lens
“What is Meaningful Insurance?”
- Policy Review Group

• Phase 1 – Principles statement and

evaluative tool (2006)
• Phase 2 – Incentives for prevention in the
health systems (March 2007)
• Phase 3 –Costs (October 2007)
• Additional research underway
 Phase I:
Principles Statement

How will we evaluate meaningful insurance

The Four A’s:
• Adequacy
• Affordability
• Availability
• Administrative Simplicity
Phase I:
The Evaluative Tool

• A detailed list of questions the Society will ask

about any reform proposal or health care system
• May be applied to different models of health care
reform or change
• Provide the basis for developing practical and
more specific evaluative criteria in the four main
areas: adequacy, availability, affordability, and
administrative simplicity
• Accessible to all volunteers and field staff
• The Society is not currently offering its own plan,
but rather will evaluate proposals put forth by
others and decide whether to support them
Threshold Questions

I. Does the proposal contain the essential

components: adequacy, availability,
affordability, and administrative simplicity?

II. Does the reform plan reduce or eliminate

segmentation ( “cherry picking ”) of the health
insurance market?

III. Is the financing of the reform adequate to

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

• Began April 2005 – Georgetown University

partnering 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 the

current health care system through the cancer lens
Partnerships and Collaborations
One compelling message…
Access to Care Messaging
What good is a health care system if it
can’t help those who need it?

What kind of health care system is it if

you have to beg for the opportunity to
fight cancer?

Is the choice between losing your life

and losing everything really a choice?

Fighting cancer is tough enough

without having to fight for the help
you need.
www.acscan.org
Access to Care Petition
Advocacy:
Current Work
• Aggressive advocacy work at the state and
federal levels to expand access
• SCHIP
• NBCCEDP
• Establish CRC pilot screening & treatment
program for the uninsured; and ensure
coverage for all Americans
• Fund patient navigators
• Provide access to cessation and clinical
trials
• Eliminate barriers to prevention in Medicare
• Preserve existing coverage