Disparities in Health Insurance Coverage

Unlike most developed countries, the United States does not have universal health insurance. Instead, health insurance coverage is delivered through a complex mix of public (federal and state) and private (employer-sponsored and individually purchased) options, with wide variation in benefits, premiums, and cost-sharing, which includes copayments, coinsurance, and deductibles. 

As the graph above shows, in the US, whether or not a person has health insurance determines their access to care across the cancer control continuum. Health insurance can also determine whether or not a person can access care for other conditions, such as diabetes and heart conditions. 

The Affordable Care Act (ACA), enacted in 2010, significantly reshaped the US health insurance landscape.

People without health insurance or with inadequate coverage may have breakdowns in care in one or more places across the cancer control continuum.

Prevention and screening breakdowns may occur because without quality health insurance coverage, people are less likely to have a usual source of care to recommend it. 

When screening does occur, people with no or inadequate health insurance coverage are less likely to receive timely follow-up of any abnormal findings, which has the potential to result in a diagnosis at a later stage of disease. 

When people are diagnosed with cancer and they have no or inadequate health insurance coverage, they are less likely to receive timely treatment that is consistent with guidelines, including palliative care. People with no or inadequate health insurance also have worse survival following a cancer diagnosis.

At the end of life, people without health insurance or with inadequate coverage are less likely to receive quality end-of-life care.