A study co-authored by Soumitra Bhuyan, executive director of the Health Administration Programs and associate professor at the Edward J. Bloustein School of Planning and Public Policy, said that while out-of-pocket expenses decreased in some groups, the overall burden to family income of cancer patients has not improved since the implementation of the Affordable Care Act (ACA).
As the second-leading cause of death in the U.S., cancer often leaves victims and survivors with a substantial financial burden. The ACA initially set out to improve health care affordability by reducing out-of-pocket expenses for a disease with expensive treatment and high national prevalence.
According to Bhuyan, the team found that after the ACA, out-of-pocket spending decreased across different income groups. Most notably, they found a 48.3 percent and 51.5 percent decline in the lowest income and second lowest income group respectively. But thegeneral financial burden related to income did not subside.
According to Bhuyan, the United States spends approximately 18 percent of its per capita GDP on health care, but Americans still have poor access to resources. One important determinant of health care access is insurance. Before the ACA, the rate of Americans who were uninsured was significantly higher.
The study utilized data from the Medical Expenditure Panel Survey (MEPS), which is a nationwide survey on medical health costs, to analyze data for cancer patients between the ages of 18 through 64, Bhuyan said. The team compared data from 2010 to 2019, with specific emphasis on 2014 — when major provisions of the ACA were implemented — to analyze the effectiveness of the legislation.
The study claims that the burden on family income highlights a gap between medical coverage and financial protection. Bhuyan said that the cost of cancer care is significantly rising, leading to extreme debt — often dubbed financial toxicity — from cancer treatment. He added that a potential solution could come from a restructuring of programs within health care organizations to better address this rising cost of treatment.
The study highlights the importance of financial education and insurance literacy in navigating medical treatment costs. Expansions of insurance, including the efforts of the ACA, do not automatically mean patients understand the other complex aspects of medical bills, like benefit design, cost-sharing requirements and available financial assistance programs.
Bhuyan said that a key limitation from the study is that the data is pulled nationally, which means the data did not account for insurance premiums or state-specific Medicaid policies. The study suggests that future research should look into the effects of financial education on the financial burden of cancer costs.
“I think having a good understanding of the insurance plan is always important irrespective of your age group,” Bhuyan said. “A lot of people don’t want to look at it until they are faced with a life threatening severity … We should be more knowledgeable about our insurance production plan for sure and specifically around those important, life-changing events.”