Adcox returned to the Charleston College of Medicine in South Carolina last May to seek treatment, 18 months after learning in April that she had skin cancer.
By then, the reddish patches along her hairline had grown from a two-inch circle to covering nearly the entire forehead. It leaked fluid and was painful.
“Honestly, I was waiting to die,” said the 41-year-old mother of three from Easley, South Carolina.
After a biopsy diagnosed him with basal cell carcinoma, Adcox first met with a doctor at an academic medical center in late 2020. She was told that the surgery to remove her cancer would require several doctors because it is so close to her brain.
But Adcox was uninsured. She had lost her car factory job early in the pandemic, and at the time of her diagnosis, she was equally panicked about the complex surgery and potential large bills. Instead of advancing her treatment, she tried to camouflage her growing cancerous area for over a year with her hat and long bangs.
If Adcox had developed breast or cervical cancer, she could be covered under federal law expanding Medicaid eligibility to low-income patients diagnosed with those two malignancies. Like almost all male patients, female patients with other types of cancer have few options. South Carolina and 11 other states According to oncologists and health policy experts who study access to care, they are those who have yet to implement Medicaid expansion.
Faced with potentially daunting bills, uninsured adults may delay treatment. research showLike roulette, the odds of a patient taking out insurance to cover the cost of treatment depend on where they live and the type of cancer they have.
Evan Graboyes, M.D., a head and neck surgeon and one of Adcox’s internists, said: “Whether you live or die from cancer shouldn’t really have anything to do with the state you live in.”
The Affordable Care Act gave states the option to expand Medicaid eligibility and cover more people. Immediately after the law was passed, Only 2.6% of adults aged 18-64 A study published in JAMA Oncology in 2018 found that 7.8% of states with Medicaid expansion had no insurance, while states without expansion had new cancer diagnoses. I was. cancer every year.
However, in all states, uninsured, low-income breast or cervical cancer patients may have access to alternative coverage pathways, even if they are not eligible for Medicaid.Adults with Cancer Found National Breast and Cervical Cancer Early Detection Program Through advocacy and federal legislation that began more than 30 years ago, you can enroll in Medicaid while you’re on cancer treatment.
In 2019, 43,549 breast and cervical cancer patients were registered, according to the National Cancer Institute. Government Accountability Office Report Published in 2020.
“If you’re lucky enough to be diagnosed with breast or cervical cancer, you’ll be fine,” says a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City, who studies cancer treatment access and affordability. said Fumiko Chino, M.D. “But otherwise, some serious failures can occur.”
The amount billed to your insurance company in the first year after being diagnosed with cancer can be high.For example, average cost in 2016 $168,730 for lung cancer, $137,663 for colorectal canceraccording to a 2022 study that calculated insurance claims for several common malignancies diagnosed in privately insured patients.
Because uninsured adults may struggle to obtain preventive care, cancer may not be detected until it is advanced, costing patients and the health system, says the JAMA Oncology study. Author, American Cancer Society.
Patients who do not receive financial assistance through safety net facilities may accumulate medical debt, use credit cards, or initiate fundraising efforts through online sites. I hear stories of people mortgaging.”
Cancer patients can purchase insurance through the ACA Health Insurance Marketplace. However, in many cases, you have to wait until the regular enrollment period near the end of the year, and these health insurance plans do not become effective until the beginning of the next calendar year.
Marybeth Musumesi, an associate professor of health policy and management at George Washington University in Washington, D.C., said federal law is designed to encourage people to sign up when they’re healthy, so costs should be kept down. “It would encourage people to stay uninsured while they are healthy and don’t think they will actually need coverage,” she said.
Meanwhile, the entry into Medicaid coverage for low-income patients with breast and cervical cancer is a story of advocacy success, 1990 Act Created a national breast and cervical screening program.Mammography started Widely recommended in the 1980sand advocacy groups are striving to reach out to more underserved individuals, said Katie McMahon, policy director for the American Cancer Society Cancer Action Network, the organization’s advocacy arm. .
However, research shows that some adults without insurance are having trouble getting treatment for cancers detected through screening programs, said McMahon.2000 law of the year States Allowed to Extend Medicaid By 2008, all 50 states and the District of Columbia had done so, according to the 2020 GAO report.
For other cancer patients, one remaining recourse is to obtain disability eligibility through the Social Security Administration, Chino said. Then you can apply for Medicaid. Federal agencies have long list of criteria for cancer patients. again, Compassion Allowance Programprovides rapid reviews of patients with certain serious medical conditions, such as advanced or aggressive cancers.
Rules vary, but many patients don’t qualify until the disease has spread or the cancer requires at least a year of intensive care. It shows a catch-22 that’s unique to people with cancer, she said.
“You have to wait until the cancer is incurable to qualify for Medicaid,” she said.
For example, the Compassionate Care Program does not list basal cell carcinoma and is only covered if head and neck cancer has spread elsewhere in the body or cannot be surgically removed.
Adcox said she was still pending an application for financial assistance to the Medical College of South Carolina before performing the 12-hour surgery last June. Someone at the hospital estimated her bill at $176,000 and she asked how much she could pay Adcox, she recalled. She raised her $700 with the help of her family.
However, she is eligible for financial assistance and has not received any invoices, except those from external lab service providers. She’s “done,” Adcox said. She has since undergone radiation therapy and will undergo further reconstructive surgery. But she doesn’t have cancer. “It didn’t kill me. It didn’t kill me.”
Still, not everyone can find the safe way.
El Paso, Texas resident Brian Becker was uninsured and not working when he learned he had chronic myelogenous leukemia in the summer of 2021, according to his ex-wife and mother of young daughter Stephanie Gamboa. said. His cancer doctor demanded an advance and it took her several months to borrow enough money, she said.
He began chemotherapy the following year, Gamboa said, and over the course of several months lost weight and wasted away, returning to the emergency room with an infection and worsening kidney function. “He couldn’t get out of bed. He was literally skin and bones,” Gamboa said.
Becker has started the process of applying for disability benefits. A text he sent to Gamboa, which Gamboa shared with his KHN, said he expected the review of his application to begin in June 2022 and take six months.
Rejection letter dated February 4, 2023 arrived over a month later Becker’s death in December At 32, some wrote:
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