Original Article

Supportive Care in Cancer

, Volume 21, Issue 2, pp 377-383

Employer-sponsored health insurance coverage limitations: results from the Childhood Cancer Survivor Study

  • Anne C. KirchhoffAffiliated withCenter for Children’s Cancer Research, Huntsman Cancer Institute, University of UtahCancer Control and Population Sciences Research Program, Huntsman Cancer Institute, University of UtahDepartment of Pediatrics, University of Utah Email author 
  • , Karen KuhlthauAffiliated withMassachusetts General Hospital
  • , Hannah PajolekAffiliated withMassachusetts General Hospital
  • , Wendy LeisenringAffiliated withFred Hutchinson Cancer Research CenterUniversity of Washington
  • , Greg T. ArmstrongAffiliated withSt. Jude Children’s Research Hospital
  • , Leslie L. RobisonAffiliated withSt. Jude Children’s Research Hospital
  • , Elyse R. ParkAffiliated withMassachusetts General Hospital

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Abstract

Purpose

The Affordable Care Act (ACA) will expand health insurance options for cancer survivors in the USA. It is unclear how this legislation will affect their access to employer-sponsored health insurance (ESI). We describe the health insurance experiences for survivors of childhood cancer with and without ESI.

Methods

We conducted a series of qualitative interviews with 32 adult survivors from the Childhood Cancer Survivor Study to assess their employment-related concerns and decisions regarding health insurance coverage. Interviews were performed from August to December 2009 and were recorded, transcribed, and content analyzed using NVivo 8.

Results

Uninsured survivors described ongoing employment limitations, such as being employed at part-time capacity, which affected their access to ESI coverage. These survivors acknowledged they could not afford insurance without employer support. Survivors on ESI had previously been denied health insurance due to their preexisting health conditions until they obtained coverage through an employer. Survivors feared losing their ESI coverage, which created a disincentive to making career transitions. Others reported worries about insurance rescission if their cancer history was discovered. Survivors on ESI reported financial barriers in their ability to pay for health care.

Conclusions

Childhood cancer survivors face barriers to obtaining ESI. While ACA provisions may mitigate insurance barriers for cancer survivors, many will still face cost barriers to affording health care without employer support.

Keywords

Employer-sponsored health insurance Childhood cancer survivors Affordable Care Act Insurance reform