According to ProPublica, a Michigan lawmaker has proposed a bill to ensure unimpeded access to cutting-edge cancer treatments for state residents following its investigation into a case where an insurer denied coverage for a life-saving therapy.

2/3rds of Bankruptcies in America are because of Medical Bills.

Hassle-free Financial Assistance with Medical Treatment and Other Costs. No Lawsuit.

Medical bills are by far the biggest cause of bankruptcy in America.

There is some financial assistance through workers compensation and veterans disability, but it’s often not enough.

The proposed legislation, championed by Senator Jeff Irwin (D-Ann Arbor), stems from the tragic story of Forrest VanPatten, a 50-year-old father of two who succumbed to cancer in February 2020. VanPatten’s last hope for survival hinged on CAR-T cell therapy, a novel treatment that engineers a patient’s own immune cells to fight cancer.

However, his insurer, Priority Health, refused to cover the treatment, citing internal debates around its classification as a “gene therapy” rather than a drug.

Advanced cell therapy for cancer can be costly, and insurers increasingly try to shift the costs to patients.

Michigan’s existing law mandates coverage for established cancer treatments, but ambiguity surrounding newer forms like CAR-T created a loophole exploited by the insurer. Senator Irwin’s bill seeks to clarify the state’s mandate, explicitly including genetic and immunotherapies within the scope of covered treatments. This move aims to ensure unambiguous patient access and eliminate any room for misinterpretation by insurers.

Unfortunately, this new proposal has yet to become law in Michigan, and families face similar challenges in other states nationwide.

Cost Concerns May Have Been the Motivation Behind the Denial

According to former employees who spoke with ProPublica, Priority Health’s primary motivation for denying CAR-T coverage stemmed from its high cost. Dr. John Fox, who served as Priority Health’s associate chief medical officer then, revealed that internal discussions were heavily focused on avoiding payment due to the treatment’s expense. Fox, a vocal advocate for the therapy and its inclusion under Michigan’s mandate, eventually left the company in 2019, disillusioned by their stance on life-saving cancer treatments.

Insurer says the advanced cancer treatment should not be covered by the policy.

Priority Health, however, maintains its position. A statement claims a “lack of consensus” within the medical community regarding the treatment’s efficacy during its initial approval. It further states that coverage was initiated only after “extensive clinical work improved the treatment.” However, leading cancer treatment centers had already established substantial consensus regarding its effectiveness well before the VanPatten case.

When approached about the bill, Priority Health spokesperson Mark Geary reiterated the company’s compliance with existing regulations and current CAR-T cell therapy coverage provision. He expressed the company’s continued willingness to collaborate with lawmakers and regulators to ensure affordable access to evidence-based treatments for Michigan residents.

Michigan Regulators Now Face Scrutiny

The ProPublica investigation exposed the VanPatten case and shed light on a lack of enforcement by the Michigan Department of Insurance and Financial Services (DIFS). Despite a mandate requiring cancer treatment coverage implemented in 1989, the department acknowledged failing to cite a single insurer for violation.

Under existing law, the DIFS can impose fines, suspensions, and even license revocations upon non-compliant insurers. However, they haven’t utilized these measures in the past. Through Communications Director Laura Hall, the department expressed their support for Senator Irwin’s proposal, indicating their alignment with efforts to solidify cancer patient protection within state law.

The Financial Burden of Cancer Treatment: When Safety Nets Fall Short

The fight against cancer extends far beyond the physical toll. For many, the financial burden becomes a crippling secondary battle, especially for those relying on programs like Supplemental Security Income (SSI) or Veteran disability benefits. While these programs offer a lifeline, they often fall short in the face of skyrocketing cancer treatment costs.

Cancer patients also may have travel and lodging costs associated with treatment, on top of lost income and alarming medical bills.

According to one study, among all cancers, adult patients and caregivers in the U.S. spent between up to $2,600 per month on out-of-pocket costs related to cancer treatment. These costs can be impossible for individuals on fixed incomes, like those receiving SSI. As of 2024, the Social Security Administration set the maximum federal SSI benefit for an individual at $943 per month for an individual and $1,415 for a couple. This amount is meant to cover basic needs like food and housing, leaving little to no room for the additional expenses associated with cancer treatment.

Veterans disability benefits do not always cover all of a cancer patient’s costs.

Veterans face similar challenges. While Veteran disability benefits can provide some financial assistance, the amounts awarded are based on the severity of a service-connected disability. They may not be enough to cover the high cost of cancer treatment.

The combination of high treatment costs and inadequate financial support creates a precarious situation for many battling cancers. They may be forced to choose between essential care and necessities, which can have life-altering consequences. This highlights the urgent need for additional support systems to bridge the gap between what safety net programs provide and the true cost of cancer treatment.

Looking Forward: A Push for More Equitable Access

While the proposed bill might not be a universal solution, encompassing all health plans in Michigan, it marks a significant step towards greater accessibility to cutting-edge cancer treatments for state residents. Notably, employer-sponsored plans regulated by the federal government are exempt from such state mandates. However, some choose to follow them voluntarily, raising hope for broader coverage in the future.

The fight for guaranteed access to life-saving treatments continues.

Still, the proposed legislation offers a ray of hope for Michigan cancer patients, promising a clearer path toward receiving the care they desperately need.

A Glimmer of Hope for Some: Asbestos Trust Funds and the Fight Against Cancer

While the financial burden of cancer treatment can feel overwhelming, there is a little-known resource that can offer significant financial assistance for those whose conditions may be linked to asbestos exposure. Asbestos trust funds hold billions of dollars set aside by companies that manufactured or used asbestos, and they are readily available to eligible individuals.

What is asbestos, and does it cause cancer?

Yes, asbestos is known to cause cancers of the lungs, throat, stomach, colon-rectum, and ovaries, as well as mesothelioma, an aggressive and fortunately rare type of cancer caused almost exclusively by asbestos.

Asbestos, once widely used in construction and various industrial applications, is now known to cause several serious health problems, including mesothelioma, lung cancer, and other asbestos-related diseases. In the wake of numerous lawsuits against asbestos companies, many of these companies filed for bankruptcy, leaving behind a financial responsibility to compensate future victims. Asbestos trust funds were established to fulfill this obligation and settle outstanding claims.

Who is Eligible to Collect from an Asbestos Trust Fund?

The eligibility criteria for these funds vary based on the specific trust. Still, generally, they are open to individuals diagnosed with an asbestos-related disease who have documented exposure to asbestos products manufactured by the companies associated with the specific trust. This exposure can occur in various ways, such as working in environments where asbestos was used, living near an asbestos processing facility, or even through secondary exposure from family members who worked with asbestos.

Contrary to the often complex and lengthy legal process associated with lawsuits, accessing funds from asbestos trust funds is remarkably straightforward. No depositions, court fees, court appearances, or legal adversaries are involved. However, legal assistance is highly encouraged. If the step-by-step process is not followed exactly as required, a claimant could be disqualified.

The process typically involves:

· Contacting the trust directly: Each trust has a dedicated phone number or website where you can initiate the claim process.

· Providing basic information and documentation: This typically includes medical records confirming your diagnosis, details about your potential asbestos exposure, and any supporting documentation you may have.

· Review by the trust: The trust will review your information and determine your eligibility based on their established criteria. This process usually takes a few months.

· Receiving compensation: If deemed eligible, the trust will award you a predetermined amount based on your specific condition, medical expenses, and other factors.

Beyond the ease of access, asbestos trust funds offer several significant advantages over traditional lawsuits:

· Reduced risk: Unlike lawsuits, you don’t risk losing your case and incurring additional legal costs.

· Faster access to funds: Compared to the lengthy process of a lawsuit, receiving compensation from a trust fund can be much faster, often within months.

· Guaranteed compensation: If you meet the eligibility criteria, you are guaranteed a payout, unlike the uncertain outcome of a lawsuit.

While asbestos trust funds offer a valuable source of financial support, it’s crucial to remember the following:

Every trust has its own claim deadline. Therefore, initiating mesothelioma cancer claims as soon as possible after receiving your diagnosis is essential.

Legal assistance is highly recommended. While the process is fairly straightforward, asbestos lung cancer lawyers can help you understand your options and maximize your potential compensation. They will also ensure you don’t miss a necessary step or a deadline along the way which could disqualify you.

Trusts are limited in scope. Asbestos trust funds are primarily intended for individuals with mesothelioma and other asbestos-related diseases. They may not be available for other types of cancers unrelated to asbestos exposure.

It is important to find the right trust. Identifying the appropriate trust funds requires research. Numerous resources are available online and through legal professionals specializing in asbestos-related claims. These resources can assist you in determining which trusts you may be eligible for based on your specific circumstances and exposure history.

While asbestos trust funds offer relief to some, the fight against asbestos-related cancers unfortunately extends beyond financial assistance. A critical challenge lies in the underreporting of these insidious diseases, often leaving victims unaware of their rights and the financial resources available to them.

In 2021, the CDC raised alarming concerns, highlighting that the mesothelioma rate in women, asbestos-related cancer, had increased over the past two decades and continued to be underreported. Notably, nearly 20% of these women identified as homemakers, individuals with no apparent reason to suspect exposure. This stark reality exposes the misconceptions surrounding asbestos exposure and its far-reaching impact beyond traditional occupational settings.

Further complicating the matter is the extensive latency period associated with asbestos-related illnesses. These cancers and health problems, like mesothelioma, can take 20 to 50 years to manifest, often leaving individuals unaware of the connection to past exposure. As one researcher aptly stated, “Many patients, especially women, were unaware they had been exposed to a time bomb with a very long fuse.”

Given these alarming trends, it becomes crucial to emphasize the importance of early detection for individuals at risk. This includes:

· Former asbestos workers: Individuals who worked directly with asbestos in industrial settings before 1982, when regulations were less stringent, are at elevated risk.

· Household members of industrial workers: Exposure can also occur indirectly through contaminated clothing or dust brought home by family members handling asbestos.

Researchers emphasize that asbestos exposure remains the leading cause of occupational lung cancer deaths. To combat this silent threat, they recommend screening for asbestos scarring in individuals aged 50 and above who fall into these high-risk categories. Such proactive measures can lead to earlier diagnosis and treatment, potentially improving prognoses and empowering individuals to access resources like asbestos trust funds.

By addressing the underreporting of asbestos-related cancers and promoting early detection strategies, we can empower individuals to navigate the challenges associated with these illnesses and seek the support they deserve.

Fighting Cancer Requires Advocacy and Collaboration

While the proposed bill championed by Senator Jeff Irwin offers a beacon of hope for Michigan cancer patients, it also underscores the broader challenges faced by patients nationwide in navigating the complexities of healthcare coverage, particularly when faced with high treatment costs and ambiguous insurance policies. The investigation into Priority Health’s denial of coverage sheds light on the motivations behind such decisions and the need for stronger enforcement measures to protect patients’ rights.

Thankfully, asbestos trust funds exist to help those with certain types of cancers, but it is an often overlooked resource. In addition, the underreporting of asbestos-related diseases remains a significant concern, emphasizing the importance of early detection and proactive screening efforts to mitigate the long-term impact of exposure.

Ultimately, while progress is being made in addressing these challenges, further advocacy and collaboration are necessary to ensure equitable access to life-saving treatments and support services for all individuals affected by cancer and related illnesses.