Financial Barriers to Accessing Oncology Care With Susan Escudier, MD

Patients with cancer often face multiple barriers when attempting to access and afford care. Complications to accessing care may include socioeconomic status or limited access to adequate insurance coverage.1

Susan Escudier, MD, a medical oncologist with Texas Oncology, spoke with The American Journal of Managed Care® on the current state of equity in cancer care. Escudier discussed the implications of local collaborative practices benefiting cancer patients. Often, patients who may not have health insurance or may lose their health insurance soon can still receive care from a local, county hospital, she explained. Not only did she encourage communal collaboration but also assistance on the payers' end as well. Helping patients coordinate follow-up appointments can also pillar support for patients with cancer.

Escudier spoke at the Houston regional Institute for Value-Based Medicine® event on September 9, where she was a panelist on a session titled, "No Outcome Without Access: Rewriting the Rules of Equity in Cancer Care." The panel explored systemic, financial, and research-driven strategies to advance equitable access and affordability in oncology care. However, recent federal budget cuts to Medicaid threaten to lower payments to providers, thus disincentivizing them from treating patients with Medicaid coverage.2

“In my community, there are a lot of primary care doctors now who don't take Medicaid or Medicare,” Escudier said. “I do worry about that, because the fact is that most people don't realize until they get sick or a family member does that you don't get Medicaid… until you're destitute.”

Medicaid insures every 1 in 4 adults in rural areas—a much higher rate than that of urban areas. Rural health services are facing severe consequences as Medicaid finances a significant part of rural health services.2 For example, Medicaid accounts for 25% of Nevada’s budget, and its Medicaid spending has increased over the past few years. Many states in similar predicaments will not be able to cover revenue losses, thus significantly widening equitable access to oncology care.

“Most people can't afford that. They have no idea what insurance costs,” Escudier said about persons who decide to pay for insurance out of pocket. “It's just out of the reach of most people who aren't wealthy.”

This transcript has been lightly edited. Captions are auto-generated.

Transcript

Looking forward, what partnerships (eg, between health systems, payers, and community groups) will be most critical to achieving equity in cancer care delivery?

Cancer care, like all health care, is ultimately local. We have to have local ties with our local medical societies, our local health, and our local hospitals. For example, if this patient I talked about earlier is going to lose their health insurance because now they're too sick to work, I know that I can get them in at one of my county hospitals. I know my office knows how to do that, so we all have to be able to work together like that.

We need support for how to best help these patients. Now, to me, that doesn't necessarily have to be in my office. I like it being my office, but even if the insurance company could just provide the navigation—if they could be the ones to call a patient and say, “Hey, I see you haven't gotten that CAT scan yet. Is something going on? Can we help you get that?” or “Hey, I see you haven't seen the surgeon to schedule your breast surgery.” I think things that might encourage the patients to be able to stick with their treatments.

How do you see gaps in equitable access to health care widening given the cuts to Medicaid and Medicare?

I think it will be, and I think it's very concerning. I know there's still some debate about maybe trying to save the expanded access to the Accountable Care Act insurance, but I think [there will be cuts] because I think Medicaid is already seriously underpaid, and we're going to see rural hospitals closing. We're going to see small practices closing. They already do that. We already see practices that won't take Medicaid. And most cancer practices already do. I believe nobody wants to turn away a patient with a curable cancer or a treatable cancer for lack of insurance. Sometimes we can help those patients get on Medicaid.

I worry about that quite a bit that there'll be some patients who are currently on treatments that are going to fall off. There'll be some patients who will never access it because they don't realize, for example, there's this emergency Medicaid, and sometimes you can get somebody started on treatment, like in a hospital or something, and they can expedite getting them coverage so they can continue their treatments. But I do worry about that quite a bit.

And if Medicare doesn't comp [services] and keeps decreasing what it pays providers, you're going to start to see more providers opt out. In my community, there are a lot of primary care doctors now who don't take Medicaid or Medicare. I do worry about that, because the fact is that most people don't realize until they get sick or a family member does that you don't get Medicaid unless, [for example if] you're in Texas, you have to make less than $750 a month. That's poor. Can you imagine that you make $752 and you're too rich for Medicaid? I don't know how anyone can live on that.

I think most people don't realize that you won't get [Medicaid] until you're destitute. And then [another example], let's say I'm working. I've paid insurance my whole life, and I want to keep paying for my own insurance. Most people can't afford that. They have no idea what insurance costs. If they want to say, “Okay, I'm just going to pay for the health care costs out of pocket,” or “I want to pay for my own coverage out of pocket,” it's out of the reach of most people that aren't wealthy.

References

1. Advancing Health Equity—addressing cancer disparities. American Cancer Society. Accessed October 20, 2025. https://www.cancer.org/about-us/what-we-do/health-equity.html

2. Carter J. States are already cutting Medicaid; massive federal cuts are yet to come. Medicare Rights Center. October 2, 2025. Accessed October 20, 2025. https://www.medicarerights.org/medicare-watch/2025/10/02/states-already-cutting-medicaid-massive-federal-cuts-yet-to-come