provided support to assist states with the losses incurred by high-risk pool programs.

HIPAA and COBRA provide some assurance of continuation of insurance coverage if individuals move from one job to another. Cancer survivors, however, continue to have fears regarding maintenance of health insurance—more than one-quarter of survivors expressed concerns about job lock, according to a recent study of cancer survivors’ employment-related experiences.

Some benefits needed by cancer survivors have been mandated by the federal government or by states. Women who have had mastectomies, for example, are entitled to reconstruction, prostheses, and care for complications, including lymphedema. Many cancer survivors, however, lack coverage for oral adjuvant therapies that can be very expensive. Medicare’s prescription drug plan will go into effect in 2006 and provide some coverage for drugs currently not covered by the program (orally administered cancer drugs). Until then, a pilot program has provided generous prescription drug coverage to cancer survivors in need of these drugs. Relatively few cancer survivors, however, have signed up for this program.

Very limited direct financial assistance is available through the government or voluntary organizations to offset the high costs of cancer care for those who are uninsured or underinsured. The Hill-Burton Free Care Program provides some care, and voluntary organizations sometimes provide assistance for transportation, medicine, and medical supplies. Pharmaceutical companies have patient assistance programs to help individuals with prescription drug costs, but they provide limited assistance and the application process can be onerous. The goal for those without insurance is to gain access to it through available means, for example, through a high-risk insurance pool.

The IOM Committee on the Consequences of Uninsurance, in its 2004 report, Insuring America’s Health, recommended that the President and Congress develop a strategy to achieve universal insurance coverage and to establish a firm and explicit schedule to reach this goal by 2010 (IOM, 2004a). Only through such efforts will cancer survivors, their families, and health care providers be able to fully focus on care and well-being without being burdened by financial worries. Consistent with this goal, the IOM Committee on Cancer Survivorship recommends the following steps that can be taken between now and 2010 to strengthen health security for cancer survivors.

Recommendation 9: Federal and state policy makers should act to ensure that all cancer survivors have access to adequate and affordable health insurance. Insurers and payors of health care should recognize survivorship care as an essential part of cancer care and design benefits,

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