Barbara Baker went to Rhode Island Hospital in 2017 for a routine colonoscopy and was diagnosed with stage III colon cancer.
“I had to put my energies into trying to save my life at that point,” said Baker, 58, of Pawtucket, who had a career in higher education at the time.
She started chemotherapy at The Miriam Hospital, had two surgeries related to the cancer and then had a bad accident, falling down a set of stairs and breaking her arm.
At the time, she was working full time and had what she said was a great health insurance plan with Blue Cross & Blue Shield of Rhode Island. Despite her treatment being relatively short, copayments for chemotherapy piled up, and the costs for surgery that weren’t covered by insurance tallied about $5,000.
She ended up leaving her job when she was deemed cancer-free to focus on her recovery and took out money from her retirement plan to go through the necessary survivorship programs, which help patients physically and emotionally care for themselves for life after cancer.
That totaled another $10,000.
Baker isn’t the only one finding the out-of-pocket expenses for cancer care can be overwhelming.
‘The financial burdens can bankrupt anyone or eliminate life savings.’
DR. WAFIK S. EL-DEIRY, Cancer Center at Brown University director
A new report by the American Cancer Society Cancer Action Network released recently found U.S. cancer patients spent a cumulative $5.6 billion for their own money for cancer treatment in 2018. And overall, the disease cost the country $183 billion in direct cancer-related health care spending in 2015, an amount that is projected to increase to $246 billion annually in the next 10 years, by 2030.
“Research shows that paying $5,000 or $10,000 out of pocket – often within a span of only one to three months – is extremely challenging even under the best-case scenario,” said Lisa Lacasse, president of the Cancer Action Network.
An analysis conducted by the network found that when premiums, deductibles, copayments and co-insurance were calculated, many cancer patients paid between $5,000 out of pocket for care when in a large employer insurance plan to more than $12,000 in an individual marketplace plan.
However, the cost for patients on a limited-duration plan totaled $52,000 of out-of-pocket costs, largely because the plan would not cover prescription drugs and has a deductible of more than $12,000, according to the report.
“The costs of medical care including drug costs place undue burdens on patients; no one is immune,” said Dr. Wafik S. El-Deiry, director of the Cancer Center at Brown University. “The financial burdens can bankrupt anyone or eliminate life savings.”
And the costs of cancer do not impact all patients equally.
According to an American Association for Cancer Research survey in February, which examined data from 2016, almost 60% of patients between the ages of 18 to 54 experienced financial hardship compared with almost 49% of patients between 55 and 64. In addition, more than 63% of people of color experienced financial hardship compared with 51% of non-Hispanic white patients.
An annual survey by the Board of Governors of the Federal Reserve System reported that those with less education are more likely to have trouble covering an unexpected expense such as cancer care, and suggested that a number of factors caused this setback – from higher incomes, discrimination and credit access. Cancer patients who did not graduate high school were more likely to also experience hardship compared with high school graduates and those who received some or more college education.
“These issues present real barriers that vulnerable patients and their physicians are facing within our broken health care system,” said El-Deiry.
The coronavirus has also impacted coverage in some cases because of pandemic-related layoffs, resulting in the loss of employer-based insurance benefits. According to the report, changing insurance plans midyear can cause spending spikes and higher total costs.
El-Diery said the cost of cancer care in the U.S. becomes “outrageously high” and continues to spiral out of control. And it’s no different in Rhode Island, he said.
Another issue is that patients will postpone routine screenings because of a lack of insurance coverage and financial concerns.
From the time the pandemic began in March, there was an estimated 90% drop in colonoscopies and biopsies through mid-April, compared with the same period a year earlier in Rhode Island, according to the Cancer Action Network.
Last year, state Sen. Maryellen Goodwin, D-Providence, introduced a bill that would help cover the cost of at-home colon cancer screening tests. The legislation didn’t go anywhere, but it’s expected to be reintroduced in the upcoming session.
In early October, Baker had a CT scan after becoming cancer-free. With her deductible, and already paying the $30 copayment, she received a $367 bill. She also has to have an MRI on her abdomen soon, another check on her cancer status that will include a copayment and bill.
“I have to keep going. Whether it means getting a second job or getting a higher-paying job,” said Baker. “As a survivor, I have no choice.”
Alexa Gagosz is a PBN staff writer. Contact her at Gagosz@PBN.com.
