Sick. Americans are literally sick of the financial burden vulnerable patients endure because of high out-of-pocket, healthcare-related costs. The complicated and convoluted issue has no easy solution.

Mei is a 67-year-old patient who recently underwent an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and tumor debulking. Her surgical specimens were sent for pathology review and germline biomarker testing. Based on the findings, Mei was diagnosed with stage IIIC, high-grade serous epithelial ovarian cancer with a BRCA1 pathogenic germline variant.

Inflating more than 50% since 2017, the annual price of newly launched cancer drugs averages $283,000 in 2022, according to a new report from the office of U.S. Representative Katie Porter (D-CA). Although new drugs for any condition are also seeing record-breaking high prices, the cost of new anticancer therapeutics is 3.7 times higher than that of non-oncology drugs.

Patients with cancer experiencing financial hardship during routine care are nearly 1.5 times more likely to die than those who aren’t, researchers reported in study findings published in JCO Oncology Practice.

The U.S. Department of Health and Human Services, through the Health Resources and Services Administration, awarded more than $5 million in September 2022 to 11 HRSA-funded community health centers to help underserved populations access cancer screenings and early detection services in partnership with National Cancer Institute-designated cancer centers.

Under the Inflation Reduction Act, patients will pay lower premiums for the Medicare Advantage and Medicare Part D prescription drug plans during the 2023 coverage year, the Biden-Harris administration announced in September 2022. People with Medicare prescription drug coverage will also receive better and more affordable benefits, including a $35 cost-sharing limit on covered insulin product and coverage for adult vaccines recommended by the Advisory Committee on Immunization Practices.

Making history as the single largest Navigator organization funding award provided to date, the U.S. Department of Health and Human Services, through the Centers for Medicare and Medicaid Services, invested $98.9 million in grant funding to 59 Navigator organizations in August 2022 to help consumers navigate enrollment and make health coverage more accessible.

The Children’s Health Insurance Program helped drop the percentage of uninsured children from 15% to 3.7% since its authorization by Congress in 1997, according to data from the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services released in celebration of CHIP’s 25th anniversary in August 2022.

Patients with cancer and other healthcare consumers would receive reinforcements in the fight against financial toxicity with new legislation that would “empower the Federal Trade Commission (FTC) to increase drug pricing transparency and hold pharmacy benefit managers (PBMs) accountable for unfair and deceptive practices that drive up the costs of prescription drugs.” U.S. Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA) introduced the proposed bill in May.

A pandemic is not the time to experiment with Medicaid work requirements, the Biden-Harris administration maintained in April 2022 when it urged officials in Arkansas and New Hampshire to cancel their U.S. Supreme Court hearing appeals regarding the Trump administration orders and send the matter back to the U.S. Department of Health and Human Services (HHS) for further action.

Cancer is one of the top five most expensive healthcare conditions to treat, costing the United States more than $157 billion annually. The payout from patients’ pockets may be even greater, with the cost of cancer medications alone standing at $895 billion per year. But paying for cancer during a pandemic? Even financially secure patients with healthcare coverage are struggling.

As many as 71% of patients with advanced cancer—most of whom have healthcare insurance—experience major financial hardship because of their disease, according to study findings published in the Journal of the National Cancer Institute.

Out-of-pocket prescription drug costs for beneficiaries with Medicare Part D could start to lower with improved price transparency and market competition thanks to a January 2022 proposed rule from the Centers for Medicare and Medicaid Services (CMS). The rule, which would take effect on January 1, 2023, would improve beneficiaries’ experiences with Medicare Advantage and Medicare Part D and work to improve health equity in the programs, according to CMS.

Consumers will more easily find affordable healthcare coverage in 2023, thanks to the Biden-Harris administration’s December 2021 Notice of Benefit and Payment Parameters 2023 Proposed Rule, according to the U.S. Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS). The rule also improves shopping for healthcare coverage, establishes rules to ensure people have access to care, and advances health equity for consumers purchasing Marketplace coverage.

Advancing equity, justice, and opportunity for Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) communities in the United States requires an ambitious, whole-of-government agenda, the U.S. Department of Health and Human Services (HHS) announced in December 2021. To drive that agenda, the agency launched the Biden-Harris administration’s White House Initiative on Asian Americans, Native Hawaiians, and Pacific Islanders (WHIAANHPI).

Patients now have protection against unexpected—and often extraordinarily high—medical bills. On January 1, 2022, the Biden-Harris administration’s bipartisan No Surprises Act went into effect to ban surprise billing in private insurance for most emergency care and many instances of nonemergency care, according to the U.S. Department of Health and Human Services (HHS).

Employer-sponsored health insurance premiums increased by 4% for families in 2021, bringing the average annual cost to $22,221 per family, according to the results of a benchmark Kaiser Family Foundation (KFF) Employer Health Benefits survey released in November 2021. KFF also assessed the COVID-19 pandemic’s impact on workplace health benefits, including telemedicine and mental health services.

Few political and policy issues resonate with all Americans as much as the costs of prescription medications, particularly those for acute and chronic diseases that affect the body and spirit, like cancer. Seizing the opportunity for real change, in August 2021 President Joe Biden made a major announcement about his administration’s intent to change the dynamic on the financial impact of drugs and government oversight.

On September 9, 2021, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra released the Drug Pricing Plan to combat excessive pricing or prescription drugs and reduce the prices paid by the federal government for such drugs, and to address price gouging in the industry. The plan is a part of an initiative from President Biden’s executive order on Promoting Competition in the American Economy to advance the federal government’s ability to address overconcentration, monopolization, and unfair competition in the economy.

U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra celebrated the Children’s Health Insurance Program’s (CHIP’s) 24th anniversary on August 4, 2021, a program that “for more than two decades, has been a lifeline for millions of children and families across America,” with an incredible announcement: in 2020 and 2021, CHIP provided more than 6.8 million enrolled individuals with coverage during the COVID-19 coronavirus pandemic.

When President Biden signed the American Rescue Plan Act of 2021 into law in March 2021, the administration began working to make improvements in areas such as access and affordability by increasing eligibility for financial assistance. The new law lowered premiums for most people who currently had a Marketplace health plan and expanded access to financial assistance for more consumers, and data published in July 2021 showed that from February 15–June 30, 2021, more than 1.5 million Americans signed up for new health insurance coverage using the 2021 Marketplace Special Enrollment Period (SEP).

To achieve value-based, person-centered care, the U.S. healthcare system must promote sustainability and readiness to prepare for future public health emergencies such as the COVID-19 coronavirus pandemic, the Centers for Medicare and Medicaid Service (CMS) said. In August 2021, CMS announced that the Hospital Inpatient Prospective Payment System and Long Term Care Hospital Prospective Payment System final rule will take effect on October 1, 2021, in support of that work.

In July 2021, the Biden-Harris administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury and the Office of Personnel Management, issued the Requirements Related to Surprise Billing interim final rule to restrict surprise billing. The rule applies to billing for patients in job-based and individual health plans who obtain emergency care, nonemergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

Approximately 31 million Americans now have healthcare coverage through the Affordable Care Act (ACA), according to a June 2021 issue brief from the office of the assistant secretary for planning and evaluation (ASPE). Of those, 11.3 million consumers were enrolled in Marketplace plans, 14.8 million people were newly enrolled in Medicaid, 1 million individuals were enrolled in ACA’s Basic Health Program option, and nearly 4 million previously eligible adults gained coverage under the Medicaid expansion due to enhanced outreach and increased federal funding. Additionally, insurance rates have fallen across the country since the law’s implementation 11 years ago.

The American Cancer Society, along with 14 other healthcare groups advocating for increased access to care, filed an amicus curiae—Latin for “friend of the court”—urging the U.S. Supreme Court to deny state imposition of engagement requirements, like monthly community service, for Medicaid beneficiaries. The U.S. Supreme Court is likely to spend spring deliberating and convey a judgment before the end of summer.

The rate of uninsured young adults (aged 19–25) fell by more than one third between 2009 and the first quarter of 2014 following the Affordable Care Act’s (ACA’s) Medicaid expansion, according to a February 2021 report from the Urban Institute. With the expansion, young adults also reported improved overall health, increased access to care, and fewer high out-of-pocket costs. 

More than 800 million COVID-19 coronavirus vaccine doses have been administered worldwide. However, 54% of those have been in high-income countries, which contain only 19% of the world’s population, whereas lower-middle income countries have only 33% of the vaccines for their 81% of the population. Those disparities have serious implications and limit equal access to health care, including vaccinations. The World Health Organization (WHO) is campaigning to address vaccine inequity on a global scale. 

The Biden administration’s American Rescue Plan (APR) is the largest, single piece of legislation focused on economics since Franklin D. Roosevelt proposed in his New Deal programs to pull the United States out of the Great Depression. Sweeping in scope, two of APR’s goals are to make health care accessible for all and to create formal plans for addressing racial disparities. 

From Teddy Roosevelt to JFK, presidents throughout history have sent legislation to Capitol Hill with the intent to expand healthcare coverage to more Americans. Finally, when Lyndon B. Johnson drafted a bill and pushed it through Congress by expanding sections of the Social Security Act, Medicare become an entitlement and is now implemented by the Centers for Medicare and Medicaid Services (CMS). During the past 50 years, federal health coverage has grown to include Medicaid, maternal and childcare assistance, public health programs, and prescription medication pricing.

Drug pricing is a bipartisan issue that ranks very high on public opinion polling, and patients with cancer in particular feel the effects of an unregulated market. 

Understanding correct coding strategies is an important skill that affects billing and reimbursement for value-based cancer care. Meeting the requirements for complete and accurate documentation is critical to support healthcare claims. Both nurses and advanced practice providers have responsibilities in this work.

In July 2020, U.S. President Donald Trump issued four executive orders to provide solutions to the ever-increasing price of prescription medications. One of the top domestic issues in healthcare is the price of prescription medication, particularly those deemed lifesaving, such as insulin for diabetics and drugs for patients with cancer. 

Houston, TX, Miami, FL, and Baton Rouge, LA, are three of the many cities battling repercussions from the COVID-19 coronavirus pandemic. Most daunting is the perpetuated shortage of healthcare workers as the pandemic continues to ravage the United States.

As one of the only not-entirely-pandemic-related health policy topics currently in policymakers’ discussions, lawmakers are again revisiting the high cost of prescription drugs. Voters have voiced concerns in the current economic climate, and, eager to appease in the months before the November presidential election, the Trump administration responded.

As one of the youngest members of the 2018 freshman congressional class, U.S. Representative Lauren Underwood (D-IL) has already made quite a name for herself. Eschewing, for the most part in this heightened environment, partisanship and instead concentrating on health and economic issues, the representative champions access and affordability for all Americans.

From 2015 to 2030, the costs associated with cancer will rise to $245 billion, researchers said in a report that was published in Cancer Epidemiology, Biomarkers, and Prevention.

In emergencies such as the COVID-19 coronavirus pandemic, government health agencies have the authority to grant waivers for various federal health programs. Starting on March 23, 2020, the Centers for Medicare and Medicaid Services (CMS) waived certain requirements and protocols for providers and beneficiaries.   

Drug pricing is a top legislative issue for Congress, and amid rising COVID-19 concerns, health policy topics are more pressing than ever. On March 5, Senator Martha McSally (R-AZ) introduced the Lowering Prescription Drug Prices for America’s Seniors and Families Act of 2020, which would allow Medicare to negotiate prices after a drug’s patent expires as well as cap out-of-pocket prescription spending for seniors at $3,100 per year.

As groundbreaking yet high-cost cancer treatments make their way into clinical practice, the effects of financial toxicity can put a damper on the profound effects that new, lifesaving medications can have on patients with cancer. It’s a problem that even Washington, DC, hasn’t been able to address—so what can oncology nurses do about it?

A patient is rushed to the emergency room, diagnosed, and taken to surgery immediately. The patient recovers, but weeks later a bill arrives beyond any expectation, and too often ability, to be paid. This practice has become so routine that it has its own name: balance billing or, more commonly, surprise medical billing. It strikes many Americans with the burden of their ailment once again. 

The high cost of prescription medications—often lifesaving drugs—has become an unsustainable burden for many American patients. It’s a central topic in the healthcare conversation and a complex issue with countless moving parts. National opinion polling finds that a majority of people want to see changes in drug pricing.

Few know the power that prescription medications have on the quality of life for patients more than nurses. In more than just physical ways, access to affordable drugs is essential to patient-centered care and emotional, psychological, familial, and even financial stability. For too long, the cost and availability of medicines have been barriers to health care, rather than opportunities for survivorship. 
 

On March 26, 2019, more than 40 nurses came together at the Maryland General Assembly’s Senate President’s Conference Center for the Oncology Nurses Night in Annapolis. This was the Greater Baltimore Chapter of ONS’s (GBCONS’s) third advocacy trip to the statehouse, but it was the first statewide ONS event. All four Maryland chapters were active in planning the night, and many new advocates were inspired to speak out.

Since 2016, then-candidate Trump promised he was going to bring healthcare costs under control. In a White House announcement on June 24, 2019, the president took steps to add transparency to the process by requiring insurance companies, hospitals, and physicians to identify fees and costs in public and simple ways for patients to see in advance and to understand.

Reducing the high cost of prescription drugs continues to be a priority focus for both the U.S. Congress and Trump administration, and ONS is closely monitoring and providing input on how key proposals could affect patient access to oncology care.   

According to a Gallup Poll released on April 2, 2019, Americans borrowed approximately $88 billion to pay for health care in 2018. At a National Academies of Science healthcare conference on April 4, the main takeaway was that many Americans surveyed reported that they could not afford to have a serious illness like cancer. The cost of care, even with insurance, is more than many can financially withstand. Oncology nurses know how patients must maneuver through the system to defer costs, sometimes resulting in delayed or alternative approaches to care.

Democrats control the majority of the House of Representatives, and it’s their responsibility to provide and pass a U.S. budget. As with any Congress, it’s always easier said than done. With a larger, more progressive freshman class interested in pushing more environmental, health, and welfare policy issues forward, costs will be a concern.

Nurses should initiate financial conversations with patients early and offer resources to improve access to cancer care, speakers at the ONS Center for Advocacy and Health Policy’s third annual policy summit on November 13, 2018, concluded. The event, held at the Hyatt Regency Hotel on Capitol Hill in Washington, DC, brought together nurses and industry and government experts to address the issue of financial toxicity in today’s cancer care.