Ten years ago this month, my mom was diagnosed with Stage 4 ovarian cancer. After the initial shock wore off, my family and I had to quickly come to terms with our new reality. My mom would require surgery to have her football-sized tumor removed, but she was lucky to be referred to an oncologist who specialized in female reproductive cancers.
We all loved her oncologist so much that when the referral was revoked for follow-up chemotherapy treatment, we were jolted. My parents were forced to change their insurance coverage so she could keep her oncologist. Despite these hurdles and an initial prognosis of only 18 months to live, my mom beat the odds and is as healthy as she’s ever been.
Many men and women with cancer aren’t as lucky as my mom and disparities in cancer morality and survivorship are well documented—especially among African Americans. One of the biggest contributors to this disparity is the increased rate of uninsurance and underinsurance among communities of color. If you don’t have quality, affordable health insurance, you’re going to struggle to find and pay for the services of an oncologist who will oversee and provide your cancer treatment.
Of course, cancer treatment is not the only specialty treatment that uninsured and underinsured patients struggle to find. Without insurance, many of these individuals are still able to receive high-quality primary care through safety nets or other charity care systems. However, as soon as they are diagnosed with a condition that requires a specialist, the safety net cannot always meet their needs. Due to low payment rates, high demand, and inability of patients to pay out-of-pocket medical costs (PDF), specialty providers in Colorado often won’t or can’t afford to treat uninsured patients or patients on Medicaid. More Americans are enrolled in health insurance than ever before, but this problem persists, especially for populations like immigrants without documentation who aren’t eligible for public health insurance programs or subsidies on health insurance exchanges, and people living in rural communities.
Local communities and health systems in Colorado have been attempting to address this specialty care gap for many years. Safety net clinics, like Doctors Care, connect uninsured patients to specialty care services. A number of Colorado’s health alliances are attempting to take a community-wide approach to increasing access to specialty care by building specialty care referral systems and e-consult programs. ECHO Colorado is building capacity for primary care providers to treat specialty care conditions in primary care settings by increasing their knowledge of specialty interventions. Given the systemic nature of this problem; however, we will need to continue to make large-scale changes to our payment systems and health insurance eligibility if we truly want to create solutions for everyone.
Around the same time as my mom was diagnosed, several other women with ovarian cancer were in the local headlines because they couldn’t get the specialty care treatment they needed. Each of these women couldn’t obtain quality health insurance for different reasons, including lack of citizenship status or inability to afford a health plan, and they ultimately shared the same tragic fate in the end: death. I thank the health care system every day for saving my mother’s life, but I won’t stop working until everyone is offered that same opportunity to thrive.