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Despite major advances in cancer research, screening, and treatment over the past few decades, not all Americans with cancer have benefited equally. Although the rate of cancer-related death has decreased 14% between 1991 and 2004, racial and ethnic minority patients continue to die disproportionately from cancer, even after adjusting for insurance status and income.1 Factors contributing to cancer health disparities include limited access to cancer care because of lack of insurance or underinsurance, lower quality of cancer care, lower socioeconomic status, and cultural and social factors.2 In 2010, the Affordable Care Act (ACA) was signed into law, marking the most comprehensive health care reform since the creation of Medicare and Medicaid in 1965. The major provisions of the ACA serve to decrease the number of uninsured Americans, partly by expanding Medicaid coverage to an additional 20 million individuals. Other reforms set forth by the ACA are aimed at improving health care outcomes and streamlining health care delivery via several mechanisms: the creation of accountable care organizations (ACOs), a shift away from fee-for-service payment structures to payment bundling, and increased funding for comparative-effectiveness research. Although the ACA provides several opportunities to reduce or eliminate cancer health disparities, very little in the law actually addresses the affordability of care. In fact, current political and economic climates have placed major aspects of health care reform in peril. National health expenditures as a percent of the US gross domestic product (GDP) totaled 5% in 1965 but are expected to total 20% by the middle of this decade.3 Although spending on cancer care constitutes only 5% of the overall health care budget,4 these costs continue to rise at a more rapid pace than any other area of health care.5 Debates over entitlement reform and sequestration cuts have brought health care costs to the forefront. In the current climate of cost-consciousness, how can health care reform simultaneously address health disparities and the cost of cancer care? With sequestration in place and looming cuts to entitlements, we focus on forthcoming changes to Medicaid, Medicare, and payment structures and how these will affect disparities in cancer care.

Cancer Health Disparities and the Cost of Cancer Care: Payment Model Issues