health insurance that is adequate and affordable. For example, policy makers could provide federal support to improve state high-risk pools—through premium subsidies, lower cost-sharing options (e.g., lowering copayments and deductibles), expanded coverage for prescription drugs, and elimination of preexisting condition exclusion periods. This could help such programs better serve the needs of people with serious and chronic health conditions. Federal programs that guarantee availability of coverage (e.g., those provided under the Consolidated Omnibus Budget Reconciliation Act [COBRA] and the Health Insurance Portability and Accountability Act [HIPAA]) could also be expanded to include premium subsidies. Because federal legislation generally covers only federal programs such as Medicare and Medicaid, many health insurance reforms must also be addressed at the state level.

Policy makers can also improve other existing programs aimed at improving health insurance coverage of cancer survivors. In 2000, Congress established a new eligibility category option in Medicaid for uninsured women with breast and cervical cancer. However, only women screened through CDC-funded programs are eligible for this Medicaid coverage, and CDC-funded programs today reach fewer than 15 percent of the program-eligible population. Policy makers could strengthen and build on this program, first by ensuring that more eligible women with breast and cervical cancer are reached by it, and second by expanding Medicaid eligibility to include other cancer patients and survivors who have no other coverage options.

All health insurance in the United States, including Medicare, Medicaid, employer-sponsored group health plans, and individually purchased policies, should cover effective cancer survivorship care. National coverage standards should be promulgated and include interventions for which there is good evidence of effectiveness (e.g., certain post-treatment surveillance strategies, treatments for late effects, interventions for symptom management, rehabilitative services). Importantly, coverage standards should include the development of a post-treatment plan of survivorship care (see Recommendation 2). National coverage standards should evolve with the development of clinical guidelines and evidence-based research into the quality and effectiveness of care. Congress has already taken preliminary steps to assure adequacy of some cancer survivorship care. The Women’s Health and Cancer Rights Act requires health insurance to cover reconstructive surgery, prostheses, and care for complications following mastectomy, including lymphedema. This model could be expanded to assure minimum federal standards for all cancer survivorship care under all health insurance.

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