Cancer Patients Often Stranded in Health Insurance Nightmares

By Amanda Gardner
HealthDay Reporter

THURSDAY, Feb. 5 (HealthDay News) -- Last summer, Keith Blessington had just been told that he was eligible for private health insurance to replace his government-funded COBRA coverage when it ran out.

Then, the 55-year-old New Hampshire resident was diagnosed with late-stage stomach cancer, and everything changed.

Although the COBRA coverage paid for most of the cost of his initial surgery, by the time he got out of the hospital having had half his stomach and eight cancerous lymph nodes removed, Blessington found himself ineligible for virtually any private health insurance, because his cancer was now a daunting preexisting condition.

Blessington is still one of the lucky ones, because he managed to secure insurance through New Hampshire's high-risk insurance pool. However, the coverage is costly, $1,120 a month to be exact.

Just to survive while he was unable to work, Blessington borrowed $40,000 on his credit card and cashed out his 401K retirement plan.

"I have enough money for another month or so to live on. My savings are gone," Blessington, a freelance accountant, said recently.

This is just one of 20 heartbreaking stories in a new Kaiser Family Foundation/American Cancer Society report called Spending to Survive: Cancer Patients Confront Holes in the Health Insurance System. All the individuals profiled had health insurance at the time they were diagnosed with cancer.

"They're stories about how insurance just doesn't do the job," said Christy Schmidt, a co-author of the report and senior policy director for the American Cancer Society. "We need to make sure we're not just giving someone an insurance card. The insurance needs to be adequate."

The report comes soon after another study found that more than 1 million of 12 million cancer survivors living in the United States have had to forgo care, including prescription drugs, for financial reasons. The problem was most pronounced among Hispanics and blacks.

And when you have cancer, health insurance coverage is paramount. "People have worse outcomes and are diagnosed at later-stage disease if they are uninsured," Schmidt said.

Schmidt described five "lessons" to be taken away from the report:

• "There can be high cost-sharing in insurance," such as separate deductibles for different kinds of treatment and caps on benefits, Schmidt said. One woman maxed out the number of radiation treatments covered by her insurance but still needed more. She ended up not getting more radiation, even though her doctor had recommended it. One 10-year-old girl with leukemia has already reached her lifetime maximum and still needs more treatment.
• Many people become too sick to work, and lose their employer-sponsored benefits. By law, they are eligible for COBRA for 18 months, but this is often prohibitively expensive.
• The private insurance market often won't cover people who have had cancer or, if they do, the premiums are again prohibitively expensive. One man, a 10-year survivor of prostate cancer, has to pay one-quarter of his income just to cover the premiums on his policy. Often, he goes without care just to cover the costs of the policy. And that doesn't count his high deductible.
• High-risk pools will cover some cancer patients, but not all, and that coverage is expensive. According to Schmidt, the New Hampshire high-risk pool that covers Blessington is one of the "nice" plans. That premium costs Blessington about $13,000 a year.
• Other supposed public safety nets have their own problems. Some cancer patients too ill (either from the disease or the treatment) to work may qualify for disability benefits but might have to forgo Medicaid as a result. Individuals are not eligible for Medicare for two years after they have started on disability.

"I'm a cancer survivor myself," Schmidt said. "You're really fighting for your life, then you discover you're really fighting with your insurance company or your insurance doesn't do it for you, and you're in a whole other world fighting on two fronts."

More information

Visit the American Society of Clinical Oncology for more on how to handle the high costs of cancer care.