Access to Health Care: The Cancer Perspective Daniel E. Smith President, American Cancer Society Cancer Action Network (ACS CAN) November 2007

Making Progress

Incidence and mortality rates are per 100,000 and are age-adjusted to the 2000 U.S. standard population. SEER Cancer Statistics Review All Sites – Mortality Rates All Sites – Mortality Rates By Year of Death – All Races, Males and Females 1991 Baseline Goal – 50 Percent Reduction from Baseline 2015 Goal (  13.7% from Baseline) (Current trend to  36.8% from Baseline) (The latest joinpoint trend ( ) shows a -2.1 APC in age-adjusted rates) 2015 Projected Rate Rate

Odds of More Advanced Stage at Diagnosis, Breast Cancer, NCDB, InsuranceStage II vs. I Stage III or IV vs. I Private1.0 (Ref.) Uninsured 1.5* 2.9* Medicaid 1.5* 2.7* Medicare Age * Race Non-Hispanic White1.0 (Ref.) Non-Hispanic Black 1.5* 1.9* Hispanic 1.3* *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)

Odds of More Advanced Stage at Diagnosis, Colorectal Cancer, NCDB, InsuranceStage II vs. I Stage III or IV vs. I Private1.0 (Ref.) Uninsured 1.9* 2.0* Medicaid 1.4* 1.6* Medicare Age Race Non-Hispanic White1.0 (Ref.) Non-Hispanic Black 1.1* 1.3* Hispanic 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/their family member as a result of the financial cost of dealing with cancer… Used up all or most of savings Borrowed money from relatives Contacted by a collection agency Unable to pay for basic necessities like food, heat, or housing Sought the aid of charity or public assistance Borrowed money/got a loan/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 Conditions the Government Should Address? 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.

“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 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 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

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…

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. 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 it can’t help those who need it? Access to Care Messaging

Access to Care Petition

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 Advocacy: Current Work