payment policies, and reimbursement mechanisms to facilitate coverage for evidence-based aspects of care.

Cancer survivors, like all Americans, may encounter spells when no health insurance is available to them. Most uninsured Americans are not eligible for job-based health benefits (even though the vast majority are in working families) or for Medicaid (even though the vast majority have low incomes). In addition, cancer survivors, like other Americans with serious, chronic health conditions, face other barriers to coverage because of their health status. In particular, access to individual health insurance may be denied to residents in many states if they have a history of cancer. Policy makers should act to ensure that cancer survivors and others with serious chronic health conditions can obtain health insurance that is adequate and affordable. For example, federal funding could support improvements in state high-risk pools—such as premium subsidies, lower cost-sharing options, expanded coverage for prescription drugs, and elimination of preexisting condition exclusion periods. This could help such programs better serve the needs of cancer survivors (as well as people with other serious and chronic health conditions). COBRA, HIPAA, and other programs that guarantee availability of coverage could also be expanded to include premium subsidies.

Because federal legislation generally covers only federal programs such as Medicare and Medicaid, many insurance reforms must be addressed at the state level. Health insurance reforms to expand access to individuals with chronic health conditions must be considered. Whether states pursue reforms through private markets, public programs, or some other means, the goal must be to ensure that all people have access to affordable, adequate health coverage, and furthermore, that the ability to obtain and maintain such coverage is not dependent on health status.

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 less 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 screening services and 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 cover-

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