Childhood Cancer Survivorship Improving Care and Quality of Life (2003) / Chapter Skim
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7. Employment, Insurance, and Economic Issues
7. Employment, Insurance, and Economic Issues
Pages 140-165
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From page 140... ...
Selected federal and state programs are described that are of relevance to childhood cancer survivors, including Medicaid and Medicare, Supplemental Security Income (SSI) , Social Security Disability Insurance (SSDI)
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From page 141... ...
Studies conducted prior to the passage of comprehensive employment discrimination laws suggest that survivors of childhood cancer encountered substantial employment obstacles: · 43 of 403 ~ 11 percent) Hodgkin's disease survivors treated at Stanford University experienced difficulties at work that they attributed to their cancer history (Fobair et al., 1986)
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From page 142... ...
Three federal laws the Americans with Disabilities Act, the Family and Medical Leave Act, and the Employee Retirement and Income Security Act provide cancer survivors with some protection against employment .
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From page 143... ...
Other courts have followed the reasoning of the Fifth Circuit and rejected lawsuits by cancer survivors. In another case, a long-term survivor of nonHodgkin's lymphoma, fired because his employer feared that future health insurance claims would cause his insurance costs to rise, was determined not to be covered under the ADA after his dismissal (Hirsch v.
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From page 144... ...
The statute provides a number of benefits to cancer survivors: · provides 12 weeks of unpaid leave during any 12 month period, · requires employers to continue to provide benefits, including health insurance coverage, during the leave period, · requires employers to restore employees to the same or equivalent position at the end of the leave period, · allows leave to care for a spouse, child, or parent who has a "serious health condition" such as cancer, · allows leave because a serious health condition renders the employee "unable to perform the functions of the position," · allows intermittent or reduced work schedule when "medically necessary" (under some circumstances, an employer may transfer the employee to a position with equivalent pay and benefits to accommodate the new work schedule) , and · allows employees to "stack" or add leave under the FMLA to leave allowable under state medical leave law.
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From page 145... ...
. vice some legal protection for cancer survivors who encounter problems at work.
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From page 146... ...
A few states, such as California and Vermont, expressly prohibit discrimination against cancer survivors. Many state laws protect individuals with real or perceived disabilities, and therefore, cover most cases of cancer-based discrimination.
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From page 147... ...
Among survivors of childhood cancer, health insurance problems are compounded, because most survivors have only family-related insurance before the onset of cancer (Hays, 1993~. Like survivors of adult cancer, the more years that have passed since treatment, the more likely it is that childhood cancer survivors can obtain health insurance on the same terms as nonsurvivors.
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From page 148... ...
State and federal laws offer cancer survivors very limited remedies to overcome barriers in securing adequate health insurance coverage. Among those with insurance, there may be difficulties in getting reimbursement for interventions designed to prevent or ameliorate late effects of childhood cancer because of variations in the scope of benefits offered by plans.
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From page 149... ...
12101 et seq.) prohibits employers from denying health insurance to cancer survivors if other employees with similar jobs receive insurance.
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From page 150... ...
Public and private employers with more than 20 employees are required to make continued insurance coverage available to employees who quit, are terminated, or work reduced hours. Coverage must extend to surviving, divorced, or separated spouses, and to dependent children.
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From page 151... ...
Employee benefit plans that are self-insured are regulated only by federal law, not state insurance law. Unlike commercial insurance plans that employers purchase to provide health insurance as a benefit for their employees, self-insured plans are funds set aside by employers to reimburse employees for their allowable medical expenses.
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From page 152... ...
However, only limited revenues are available through state premium taxes, because the Employee Retirement Income Security Act of 1974 (ERISA) exempts self-insured plans from paying them (Achman and Chollet, 2001)
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From page 153... ...
had no specific regulation of the individual insurance market designed to improve either access to or affordability of coverage for people with significant health problems (Achman and Chollet, 2001~. Federal Health Insurance and Disability Programs Childhood cancer survivors may benefit from various federal health insurance and disability programs, most of which are designed to support those from families with low incomes.
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From page 154... ...
Of special interest to survivors of childhood cancer are services provided under Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
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From page 155... ...
Some adult childhood cancer survivors under age 65 could be eligible for Medicare if they qualified for SSDI or had ESRD. SSDI is an insurance program that provides payments to persons with disabilities based on their having been covered previously under the Social Security program, for example, through their employer.
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From page 156... ...
In the late 1970s Congress funded state CCS programs to provide case management and care coordination services to children under the age of 16 who received benefits from the SSI program (Schulzinger, 1999~. As a result of this expansion, more children with chronic illnesses, developmental disabilities, sensory impairments, and other special health needs were being served and the name of the program was changed to State Programs for Children with Special Health Care Needs (CSHCN)
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From page 157... ...
According to published eligibility criteria for Title V programs, 8 states specifically include cancer as a qualifying condition, and 8 states specifically exclude cancer as a qualifying condition. In the 8 states for which cancer is excluded, some have eligibility criteria that could make services available to cancer survivors with late effects (e.g., cardiac, neurologic, and developmental delay)
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From page 158... ...
A work group convened by the federal Maternal and Child Health Bureau in 2000 reviewed managed care issues of concern to children with special health care needs. Problems in three areas were identified that are of relevance to childhood cancer survivors: capacity and expertise in managed care organizations, access to specialized pediatric services, and reimbursement (McManus et al., 2000)
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From page 159... ...
Montana 1,379 1.5 1,088 Nebraska 4,097 2.0 488 Nevada 7,148 1.6 224 New Hampshire 4,238 3.1 732 New Jersey 67,839 8.6 127 New Mexico 12,256 4.6 375 New York 60,763 328.4 5,404 North Carolina 64,787 54.7 844 North Dakota 1,799 1.1 612 Ohio 31,572 32.7 1,036 Oklahoma 16,727 3.9 233 Oregon 7,748 3.3 426 Pennsylvania 33,593 11.5 342 Rhode Island 3,700 4.2 1,135 South Carolina 13,589 22.1 1,626 South Dakota 5,576 1.3 233 Tennessee 4,695 6.5 1,385 Texas 26,848 33.0 1,229 Utah 4,320 9.5 2,199 Vermont 3,624 1.5 414 Virginia 11,160 11.8 1,057 Washington 9,165 5.0 546 West Virginia 5,126 12.7 2,478 Wisconsin 1,896 5.5 2,901 Wyoming 3,137 2.3 733 TOTAL 517,423 1840.2 3557 SOURCE: Health Resources and Services Administration, 2000. to improve care for children with special health care needs include (Fox and McManus, 1998~: · ensuring that assigned primary care providers have appropriate training and experience, · offering support systems for primary care practices, · providing specialty consultation for primary care providers, · establishing arrangements for the comanagement of primary and specialty pediatric services,
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From page 160... ...
They do not face financial and life planning issues until several years after their cancer treatment. Since life insurance plans are based on an actuarial risk of death (or survival)
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From page 161... ...
SUMMARY AND CONCLUSIONS Since the early 1990s, significant progress has been made in improving the employment opportunities of cancer survivors. With the recent passage of federal laws such as the Americans with Disabilities Act and the Family and Medical Leave Act, as well as the expansion of many state laws, cancer survivors have gained new legal rights and remedies.
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From page 162... ...
An expansion of educational and direct services programs offered by cancer survivor advocacy organizations might also reduce and ultimately prevent employment discrimination. These programs could include attorney referral programs, personal advocacy assistance, workplace counseling to teach employers about the abilities and needs of cancer survivors to mitigate discrimination and to encourage the development of reasonable accommodations, and public educational materials and programs.
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From page 163... ...
grants may offer opportunities to learn more about effective health service delivery strategies of relevance to childhood cancer survivors (see description of these grants in Chapter 8~. REFERENCES Achman L, Chollet D
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From page 164... ...
2002. Employment Status of Adult Survivors of Pediatric Cancers: A Report from the Childhood Cancer Survivors Study (CCSS)
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From page 165... ...
1995. Health insurance access to young adult survivors of childhood cancer in North Carolina.
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