An estimated 44.8 million Americans (15.3 percent of the population) were without health insurance in 2005 (U.S. Census Bureau, 2007), and many more have only modest insurance coverage coupled with an income level that limits their ability to pay out-of-pocket health care costs (May and Cunningham, 2004; Tu, 2004). The rate of uninsurance among cancer survivors is no higher than that among the general population (and is in fact a bit lower—11.3 percent among the nonelderly),12 and among nonaged cancer survivors also is comparable to that observed in populations with other chronic illnesses, such as cardiovascular disease (12.1) and diabetes (12.6) (IOM and NRC, 2006). However, these figures offer little comfort. The adverse effects of no or inadequate insurance are well documented and include poorer health prior to receipt of care, delayed or no treatment, failure to get needed prescription medications, and worse outcomes of medical treatment for people with cancer as well as other diseases (IOM, 2002; Tu, 2004; IOM and NRC, 2006).
Further, analysis of the 2003 national Community Tracking Study Household Survey found that a majority of chronically ill working-age adults who reported health care cost and access problems had private health insurance. Thirteen percent of those with private insurance had out-of-pocket health care costs (not including costs for insurance premiums) that exceeded 5 percent of their income, and 16 percent lived in families that had problems paying their medical bills. Among those who were privately insured but had low income, more than one-third had problems paying their medical bills. Among the privately insured with such problems, 10 percent went without needed medical care, 30 percent delayed care, and 43 percent failed to fill needed prescriptions because of cost concerns (Tu, 2004). The National Survey of U.S. Households Affected by Cancer found that 10 percent of individuals with health insurance reached the limit of their insurance coverage, and 6 percent lost their coverage as a result of having cancer (USA Today et al., 2006).
Because health insurance in the United States for those under age 65 is most often obtained through employers, problems with health insurance are affected by problems with employment (Himmelstein et al., 2005). If an individual loses his or her job because of cancer, he or she also runs the risk of losing health insurance coverage—and income.