Pam Traxel [00:00:02]:

So the American Cancer Society actually authored a seminal study that said that if you don’t have health insurance, you’re likely to be diagnosed with your cancer a full stage later. What this means for cancer patients is the difference between life and death.

Intro [00:00:19]:

Welcome to Hospitals in Focus. From the Federation of American Hospitals, here’s your host, Chip Kahn.

Chip Kahn [00:00:29]:

Last year alone, the American Cancer Society estimated there were over 2 million new cancer cases. For millions and their loved ones, a cancer diagnosis brings an unrelenting focus on navigating diagnosis, treatment, and recovery. Behind the scenes, there’s a different fight taking place. The fight to ensure patients have access to the care and resources they need to survive and thrive, which depends on healthcare coverage. For so many with individual health coverage, their path to seamless, affordable care depends on the health insurance they receive in the individual market exchange and on the enhanced tax credits they receive to cover all or most of the cost of exchange coverage premiums. Despite the critical importance of these enhanced tax credits, there is an uphill battle developing in Congress to keep them available after 2025. Without them, many will no longer afford coverage. Many who are fighting cancer or other serious illness will be without the resources insurance assures.

Chip Kahn [00:01:39]:

Our guest today is Pam Traxel, senior vice president of the Cancer Action Network. Her organization is in the midst of this fight to keep the credits to sustain the coverage. Thanks so much for joining me today, Pam.

Pam Traxel [00:01:54]:

It’s my pleasure, Chip.

Chip Kahn [00:01:55]:

Pam, let’s start by looking at the expense and costs of cancer, which we know are high, and how we can assure these patients the kind of coverage they need when they’re fighting the battle of their lives in most cases. So to start with, can you tell us about the role of the Cancer Action Network and how you support the needs of cancer patients to get the coverage they depend on?

Pam Traxel [00:02:22]:

So the cancer society, actually, about 20 years ago, formed the Cancer Action Network specifically to make sure that our constituents, cancer patients and their families, could use their stories to talk to lawmakers about why public policy change is so important. And that’s really an important part of what we’re trying to do here, because what we’re trying to explain to members of Congress is why enhanced premium tax credits are so important to cancer patients and their families and what it would mean if these tax credits were allowed to expire. And I have to tell you, Chip, the news is pretty dire from patients in terms of the battle that they’re going to face if they are unable to afford their health insurance going forward.

Chip Kahn [00:03:08]:

Yeah, this is really a pretty critical case because these people are purchasing their insurance in an individual market. So they may be in the gig economy or some other kind of area where they’re self employed. So they’re generally alone. These are not people who have employer based coverage where they may have an HR department taking care of their coverage and making sure that all their needs are being met.

Pam Traxel [00:03:37]:

Absolutely, Chip. These are people who are real estate agents, hairdressers, tax preparers. They work really hard. They also happen to be battling cancer and have worked very hard to afford health insurance and make sure that they have the right kind of plan to see the right kind of doctors to fight their cancer. And this is a really challenging time for them to have to go and say potentially that next year if congress doesn’t act, that they won’t be able to afford their health insurance.

Chip Kahn [00:04:06]:

You know, I recently read an article that argued that health insurance wasn’t essential for health. And that really disturbed me, particularly when we’re talking of people who are critically ill. Can, can you give us some sense, and I think you may have some studies to refer to here, as to how important health insurance is in terms of those of us who are unfortunate enough to be diagnosed with cancer.

Pam Traxel [00:04:34]:

Yeah, Chip, this is a really important point. So the American Cancer Society actually authored a seminal study that said that if you don’t have health insurance, you’re likely to be diagnosed with your cancer a full stage later. What this means for cancer patients is the difference between life and death. So we all have a cancer experience in our lives. We all know someone that’s had cancer. We also know how important it is the stage of your cancer can be to your very survival. So if you think about it for a minute, the difference between a stage three cancer and a stage four cancer is really quite a lot. And in fact, the later your cancer stage, the higher your risk of dying from cancer is.

Pam Traxel [00:05:15]:

And all of that ties back to health insurance. Right. We have a study that specifically underlines the fact that having health insurance means that patients can be diagnosed a full stage later when cancer is eminently more treatable. But I think the other thing that’s really important is that we actually did a study that talked about being uninsured. And so if you looked at stage one cancer, so very early stage cancer, and looked at uninsured patients, they actually have worse survival rates compared to individuals with insurance who are diagnosed at stage two. This again is a very important study that the American Cancer Society did that talks about the importance of, of insurance for cancer patients. But I wanna remind folks of one thing I doubt there is a single person who listens to this podcast that woke up today thinking that they were going to be diagnosed with cancer. So when we think about health insurance, we need to think about all kinds of Americans, because someone in our country is diagnosed with cancer every 15 seconds, and in that very moment, they have the health insurance that they have.

Pam Traxel [00:06:18]:

So having health insurance is really, really important to making sure you can survive cancer, even if you don’t know that you have cancer today.

Chip Kahn [00:06:27]:

I think your work in this area also showed how many people directly were affected by the tax credits that might have these kinds of chronic conditions. What kind of numbers have you seen from your work?

Pam Traxel [00:06:39]:

Yeah, we have actually worked with a variety of people, including Oliver Weinman, to really document the number of people with chronic conditions. So let’s say diabetes, cancer, heart disease, to really figure out exactly how many folks would be impacted by these tax credits. So we have a study that shows that 1.7 million Americans living with chronic conditions would become uninsured if the tax credits expire.

Chip Kahn [00:07:07]:

And from the standpoint of those with cancer, what are we talking about in terms of the effect of, I guess, survival rates if they don’t have coverage?

Pam Traxel [00:07:18]:

So we know that survival is really dependent upon having health insurance. So we actually did a study of cancer patients and survivors to talk to them about what it would mean if they lost their enhanced tax credit. What we found from our survey is nearly half of the patients we studied said that they would not be able to afford health insurance.

Chip Kahn [00:07:41]:

I think you did other work to show what the impact would be on specific patients if they lost the enhanced tax credits. You know, how’s it going to affect their behavior?

Pam Traxel [00:07:51]:

This is probably the most shocking data that I’ve come out of from a study in a long time. In the survey that we did, we showed that 30% of those patients would agree to delay or skip medical care to reduce expenses. 25% would cancel their coverage, and 24% would incur debt in order to keep their coverage. These are some pretty shocking numbers considering that we have many patients that are in medical debt already. So this would push them into further medical debt and would definitely impact their ability to survive their cancer.

Chip Kahn [00:08:24]:

You know, this enhanced tax credit obviously goes for people in the exchanges, in the marketplaces, and the. There’s a schedule every year. The insurance is offered in the fall. People can purchase the insurance, change plans, but there’s a process that takes place all year long, and the insurance companies and health plans that provide coverage earlier in the year have to provide what their premiums would be and go to regulators and go through a process to get their rates accepted before they’re given to the premium payers, those individuals who purchase the coverage much later in the year or receive the tax credits in lieu of them having to pay for the premiums. So all of that is, you know, not far off. We’re looking at it almost, I almost say in the next many, many weeks. So we’ve got to get this done in terms of 2026. The process I’m talking about has already taken pace for 2025, and people have their 2025 coverage.

Chip Kahn [00:09:29]:

So from the standpoint of trying to sustain this coverage and persuading policymakers in the White House at hhs, and ultimately, obviously, it’s gotta take congressional action. What’s the plan? What is the Cancer Action Network doing to get its message across to try to encourage congressional action in a timely fashion?

Pam Traxel [00:09:56]:

So, Chip, we’re knee deep in reaching out to people who will be impacted by this change. This is millions of Americans. So it’s a lot of people that we have the opportunity to talk with. And really our opportunity is to take their stories and take their concern about losing these enhanced tax credits directly to members of Congress, constituent to lawmaker to explain why extending these tax credits is so critical to our effort to make sure that people have a better opportunity to fight and survive their cancer. So you will see us on the air, in communities on Capitol Hill telling the story of what this means to patients with cancer. I can think of no more important issue for us to resolve in the next Congress.

Chip Kahn [00:10:45]:

I might also point out that with the aca, that you had Medicaid expansion to people who were individuals, particularly those under 65, but still older individuals, but some states didn’t take that action. So those people fall within the exchanges, the marketplaces. I guess those people will be particularly vulnerable if Congress doesn’t sort of take this up and act as you’re, as you’re asking.

Pam Traxel [00:11:14]:

Yeah. In fact, we have 10 states that did not expand Medicaid under the ACA. These are including some very high populous states like Florida and Texas. Where to your point, Chip? A lot of those folks are on marketplace plans. So we see a record number of people that are insured in those states under the marketplace, and they will be dramatically impacted by a decision to not continue these tax credits.

Chip Kahn [00:11:39]:

This has been such a helpful conversation. I really appreciate it. Pam, I guess do you have any sort of last words for the audience before we close out?

Pam Traxel [00:11:49]:

Well, I think my last word would be many of you may not know all the details about the enhanced tax credits. You might not know, you know how many patients are impacted by this. You might not know that your friends and family are impacted by this. So I would really encourage folks to learn more. This is a very important conversation that we’re having, but I’ll admit it’s a little technical. So learning more will make a big difference.

Chip Kahn [00:12:12]:

Thanks. And I should say that we’ll have links on fah.org in the section that where we have our podcast for all the reports you discussed. And I think I’ll conclude just with this thought that even though it’s only some millions, some many millions who have the tax credit or protected by this enhanced tax credit, even those of us that are employed or have other coverage, there may become a day when we’re self employed or we’re no longer able to to work but are not eligible for Medicare or Medicaid and we could become dependent. So all of us are vulnerable to that. And so these tax credits don’t only help the people who get them, but also provide a backstop for those who in future years might need them. But that’ll only happen if we can continue them beyond 2025. So with that, I want to thank you, Pam, and wish you luck in this important effort. And we at the Federation of American Hospitals will join you, encouraging the Congress and policymakers to move forward on extending the enhanced tax credits beyond 2025.

Outro [00:13:34]:

Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more at fah.org follow the Federation on social media at FAH Hospitals and follow Chip Kahn. Please rate, review and subscribe to Hospitals in Focus. Join us next time for more in depth conversations with healthcare care leaders.

Pam Traxel serves as the Senior Vice President for ACS CAN, the advocacy affiliate of the America Cancer Society. Pam is responsible for helping ACS CAN develop relationships with companies and individuals to help further the fight against cancer through dynamic partnerships, events, and forums. Pam began her career with ACS CAN in 2007. She has been integrally involved in helping to establish ACS CAN as a nationwide advocacy organization that influences and shapes public policy at all levels of government to impact our mission and to represent the voices of all cancer patients and their families.