Insurance worries may keep cancer survivors stuck in jobs

In In The News by Barbara Jacoby

By: Lisa Rapaport


(Reuters Health) – Childhood cancer survivors may be inclined to stay in jobs they don’t like due to insurance worries or concerns about medical bills, a U.S. study suggests.

Researchers examined data on 394 childhood cancer survivors and 128 of their siblings who never had cancer. All were employed full-time, but more of the survivors reported experiencing “job lock,” or staying in the position to keep employer-sponsored health benefits.

“Because in the United States, employment is the avenue for insurance coverage for many people, people with pre-existing health conditions such as childhood cancer survivors may be at risk for insurance and employment issues that could really affect their access to health care and quality of life,” said lead study author Anne Kirchhoff of the University of Utah and Huntsman Cancer Institute in Salt Lake City.

“For survivors with health problems, they are likely using the medical system more and recognize how vital insurance coverage is to protecting their health and financial well-being,” Kirchhoff said by email.

Job lock is probably worse for people who have been denied insurance or dealt with high medical bills, Kirchhoff added.

“If someone has been denied insurance in the past, any potential changes to their insurance coverage due to changing their job may be a trade-off they are not willing to take,” Kirchhoff said.

The researchers surveyed participants just as many of the provisions of the Affordable Care Act were rolling out in 2011-2012. The ACA, also known as Obamacare, expanded insurance options outside employment for many by offering subsidized plans via the insurance marketplace and Medicaid expansion in some states.

Under the ACA, insurance companies also can’t refuse to cover people with pre-existing medical conditions like cancer, a change that may curb job lock in the future by giving people alternatives to employer-sponsored health plans, researchers note in JAMA Oncology.

In this study, about 23 percent of the survivors and 17 percent of their siblings were staying in their job to keep their insurance.

Among cancer survivors, job lock was 60 percent more common for people who had previously been denied insurance, the study found.

Survivors who had struggled with high medical bills in the past were more than twice as likely to report job lock than when they didn’t have unaffordable health bills.

Female survivors were 70 percent more likely to report job lock than their male counterparts, the study also found.

Cancer survivors with severe, disabling or life-threatening medical issues were 72 percent more likely to experience job lock than survivors in better health.

One limitation of the study is that researchers relied on participants to accurately recall and report on any circumstances that might have contributed to feelings of job lock, which may be subjective, researchers note.

Even so, the study adds to the body of evidence documenting long-term financial concerns for childhood cancer survivors, said Tara Brinkman of St. Jude Children’s Research Hospital in Memphis, Tennessee.

“Job lock is an important issue for survivors to understand because it has the potential to impede job mobility,” Brinkman, who wasn’t involved in the study, said by email.

“However, because survivors are at risk of developing late medical complications secondary to their disease and treatment, they must balance the very real need for adequate health insurance coverage with career goals,” Brinkman added. “Unfortunately, there does not appear to be an easy solution to the problem.”