New Study Reveals Popular Federal Employee Health Plan a Good Starting Point to Determine Minimum Benefits Coverage
Health Care Reform Must Ensure Access to Quality, Affordable Coverage for Families Affected by Cancer
WASHINGTON July 22, 2009 A new report finds that the most popular health insurance plan among federal employees offers adequate and affordable care for people with serious chronic diseases, making it a good starting point for defining minimum coverage benefits in health care reform legislation.
Authored by the American Cancer Society Cancer Action Network (ACS CAN) and the Georgetown University Health Policy Institute, “A Benchmark for Coverage: How the FEHBP Blue Cross Blue Shield Standard Option Plan Covers Medical Care for Patients with Serious Chronic Conditions” examines the adequacy and affordability of coverage held by most federal employees to people with cancer, heart disease and diabetes. The Federal Employees Health Benefits Plan (FEHBP) offers a number of health insurance options for federal employees and Members of Congress, and approximately half of all FEHBP participants elect the Blue Cross Blue Shield standard option (BCBSSO).
Researchers at the Georgetown University Health Policy Institute, under the direction of Professor Karen Pollitz, evaluated the plan for four serious medical conditions: stage II breast cancer; stage III colon cancer; heart attack; and type I diabetes. The report outlines the likely medical needs of patients with these conditions, estimates the out-of-pocket costs for these patients under the Blue Cross Blue Shield plan and reviews language in the plan brochure for clarity and ease of understanding.
The report finds that benefits covered under the BCBSSO plan are comprehensive, and that cost sharing for routine care is modest. However, out-of-pocket costs for patients with a serious illness are substantial, totaling $5,000 per year for patients getting all of their care from a subset of network providers designated as “preferred” and reaching $7,000 per year for out-of-network care. When out-of-pocket spending for medical care exceeds just 2.5 percent of income less for low-income persons—financial burdens on families become substantial.
“Even a strong health care plan can require chronically ill patients to spend more than they may be able to afford to get lifesaving care,” said John R. Seffrin, Ph.D., chief executive of ACS CAN. “Health care reform legislation must ensure that people with life-threatening diseases such as cancer can get the care they need at a cost they can afford.”
ACS CAN, the leading voice of patients in the health care reform debate, is working with Members on both sides of the aisle to ensure that health care reform addresses the needs of people with cancer. While the main Congressional proposals are a vast improvement over the existing health care system, ACS CAN will continue to work with lawmakers to ensure that a final bill offers the best quality care to cancer patients at a price they can afford.
The report finds that estimated out-of-pocket costs for a stage II breast cancer patient range from $10,000 to more than $13,000 for treatment over two years. For the stage III colon cancer patient, out-of-pocket costs range from $15,000 to $17,000 over the course of treatment lasting an expected three years. The estimated out-of-pocket costs for a patient who suffers a heart attack are $5,000 to more than $8,000 over the expected year of treatment. For a patient with type 1 diabetes the annual estimated costs are more than $2,100.
Forty-three million Americans had medical debt in 2007, and the decline in the economy has made the problem worse. Nearly two-thirds of bankruptcies in the United States in 2007 were due to unaffordable medical bills.
“Cancer patients with insurance across the country are digging deep into their savings and risking financial ruin to pay for their treatment and care,” said Daniel E. Smith, president of ACS CAN. “We know that lack of access to quality, affordable care continues to be a barrier in our efforts to make progress in the fight to defeat cancer, as too many cancer patients are delaying or forgoing lifesaving screenings and treatments because of access problems.”
Cancer patients are acutely aware of the gaps in the current health care system because of how extensively they access care. A health care system that works for cancer patients will likely work for anyone who needs to access it, including: ending the practice of denying coverage because of pre-existing conditions and limiting the cost burden on families by providing care that costs less and covers more.
The study shows that the Blue Cross Blue Shield standard option plan is not perfect, but it presents a guide to help define minimum adequate coverage. It offers good protection by covering the most important benefits, not imposing arbitrary benefit caps, and provides an overall limit on cost-sharing liability. However, because patients with serious and chronic illnesses could incur thousands of dollars in out-of-pocket expenses for covered care under this plan, low- and middle-income families must have cost-sharing subsidies to ensure affordability.
*For a full copy of the report, log onto www.acscan.org/federalhealthplan.
ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit http://www.acscan.org/.