Study points to cancer's financial malignancy HEALTH INSURANCE

Cancer survivor Christine Franklin talks with her 10-year-old grandson Logan Spencer as she helps him with his 5th grade homework in Vacaville, Calif., on Wednesday Feb. 4, 2009. Cancer survivor Christine Franklin talks with her 10-year-old grandson Logan Spencer as she helps him with his 5th grade homework in Vacaville, Calif., on Wednesday Feb. 4, 2009. Photo: Lance Iversen, The Chronicle Photo: Lance Iversen, The Chronicle Image 1 of / 7 Caption Close Study points to cancer's financial malignancy 1 / 7 Back to Gallery

When Christine Franklin was diagnosed with breast cancer, she spent at least $7,000 in out-of-pocket medical expenses, but was able to continue working as a busy sales executive.

But when the disease recurred last year, she had to quit her job because of the debilitating side effects of her new medications. With her income greatly reduced, she was forced to sell her Vacaville home. Franklin, who pays the monthly premium for her former employer's health coverage along with high co-payments for drugs and care, has stopped adding up the costs.

"When you have cancer, you not only lose who you were - your body no longer looks the same - but you can lose your job, and before you know it, it's a slow spiral," said Franklin, 57, who is divorced and lives on disability payments. "You feel yourself going down, like you're sliding down a hillside and the earth gives way and you're just grasping to hold on."

A report released Thursday by the American Cancer Society and the Kaiser Family Foundation found that even those cancer patients fortunate enough to have private health insurance face severe challenges paying for life-saving treatments.

Hefty out-of-pocket expenses, high cost-sharing requirements, caps on benefits and lifetime maximums on some policies are among the factors that can contribute to financial problems and lead many people to resort to bankruptcy, the study found.

"You would at least think the health care system would work for the people who are sick," said Drew Altman, president and chief executive officer of the Kaiser Family Foundation. "What this study shows is there are lots of gaps and holes and problems for the people who are the sickest in our society. That's the opposite of how health care should work."

In 2008, about 684,850 people under age 65 were diagnosed with cancer, according to the American Cancer Society. The majority - estimated as high as 70 percent by at least one study - had private health insurance.

Profiles of 20 patients

Rather than compile statistics, the study profiled 20 patients whose experiences were representative of the types of problems reported to the American Cancer Society's Health Insurance Assistance Center.

Of those profiled, nine had coverage through an employer, one paid for employer coverage, seven had individual insurance, two received coverage through a state high-risk pool, and one became uninsured.

The problems they experienced included delays in treatment as well as debt and added stress. People who become too sick to work usually can continue their employer's coverage for up to 18 months by paying the full premium, but the added expense of that coverage can pose a hardship because patients often are living on a reduced income.

Getting alternative coverage, even years after the diagnosis with no recurrence, can be a nonstarter. Insurers in the individual market routinely restrict applicants with a history of cancer. Public programs such as state high-risk pools or Medicare, which is available to those under 65 who are disabled, often have high costs and long waiting periods.

Making tough decisions

A 58-year-old Florida woman profiled in the study reached the $100,000 annual limit on her policy in 2007 after her breast cancer diagnosis. Jamie Drzewicki wound up amassing $75,000 in uncovered medical costs, a sum that was reduced to $30,000 after her hospital forgave some of the debt.

"I am a hard worker, and now I am making decisions between paying for my groceries and paying off some of my bills," Drzewicki told the study's researchers.

Tammy Witt, a 40-year-old mother of two from Ohio, initially was covered for her breast-cancer treatments with her employer's insurance, but the company changed ownership and switched to a policy that had a meager $2,500 annual benefits limit. The strain contributed to her separating from her husband and eventually forced her into bankruptcy.

Another patient, 62-year-old Thomas Olszewski from Texas, has been cancer free for nearly 10 years after his 1999 prostate cancer diagnosis, but is grappling with high premiums.

Now retired, Olszewski said he has a tough time affording his individual policy, which costs $437 a month and comes with a $3,750 annual deductible. He said he often delays lab work and follow-up care due to costs.

"A cancer diagnosis can threaten anyone with bankruptcy and financial ruin, no matter what your earning power is," Peggy McGuire, executive director of the Women's Cancer Resource Center in Oakland. "There are many paths you take, but they lead to the same destination: loss of all resources."

Sometimes patients who lose their jobs eventually qualify for Medi-Cal, McGuire said. Others may be able to get help through resources like pharmaceutical patient assistance programs, which cover the costs of certain drugs.

Struggle to pay for drug

Franklin, who was not part of the study, pays $450 a month to remain on her former employer's plan while she waits to qualify for Medicare due to disability rather than her age.

She is relieved to have insurance, but struggles to pay $658.73 each month for a cancer drug that does not have a generic equivalent and $600 every three months for follow-up scans. She now has a $100 co-payment each time she sees her oncologist because her employer switched coverage and the doctor is not in the new physician network.

Franklin, a mother of two and grandmother of three, feels fortunate to be cancer free after a clear scan in December, but always has to steel herself for the possibility of bad news in her next round of tests.

Still, she manages to keep her sense of humor. Franklin considered the cost of all the treatments she's had and compared herself to the Bionic Woman: "Sometimes you sit there and think: Am I really worth this?"

More information

-- The full study can be found on the Kaiser Family Foundation's Web site at www.kff.org.