Trump Admin Providing Data on Immigrant Medicaid Enrollees to Deportation Officials

 President Trump's administration this week provided deportation officials with personal data -- including the immigration status -- on millions of Medicaid enrollees, a move that could make it easier to locate people as part of his sweeping immigration crackdown.

An internal memo and emails obtained by the Associated Press show that Medicaid officials unsuccessfully sought to block the data transfer, citing legal and ethical concerns.

Nevertheless, two top advisors to HHS Secretary Robert F. Kennedy Jr. ordered the dataset handed over to the Department of Homeland Security (DHS), the emails show. Officials at the Centers for Medicare & Medicaid Services (CMS) were given just 54 minutes on Tuesday to comply with the directive.

The dataset includes the information of people living in California, Illinois, Washington state, and Washington, D.C., all of which allow non-U.S. citizens to enroll in Medicaid programs that pay for their expenses using only state taxpayer dollars. CMS transferred the information just as the Trump administration was ramping up its enforcement efforts in Southern California.

California Gov. Gavin Newsom's (D) office said in a statement that it was concerned about how deportation officials might utilize the data, especially as federal authorities conduct immigration raids with the assistance of National Guard troops and Marines in Los Angeles.

"We deeply value the privacy of all Californians," the statement said. "This potential data transfer brought to our attention by the AP is extremely concerning, and if true, potentially unlawful, particularly given numerous headlines highlighting potential improper federal use of personal information and federal actions to target the personal information of Americans."

HHS spokesman Andrew Nixon said the data sharing was legal. He declined to answer questions about why the data was shared with DHS and how it would be used.

"With respect to the recent data sharing between CMS and DHS, HHS acted entirely within its legal authority -- and in full compliance with all applicable laws -- to ensure that Medicaid benefits are reserved for individuals who are lawfully entitled to receive them," Nixon said.

DHS officials did not respond to requests for comment.

Besides helping authorities locate migrants, experts said, the government could also use the information to scuttle the hopes of migrants seeking green cards, permanent residency, or citizenship if they had ever obtained Medicaid benefits funded by the federal government.

A Targeted Review of Millions of Immigrant Medicaid Enrollees

CMS announced late last month that it was reviewing some state's Medicaid enrollees to ensure federal funds have not been used to pay for coverage for people with "unsatisfactory immigration status." In a letter sent to state Medicaid officials, CMS said that the effort was part of Trump's Feb. 19 executive order titled "Ending Taxpayer Subsidization of Open Borders."

As part of the review, California, Washington, and Illinois shared details about non-U.S. citizens who have enrolled in their state's Medicaid program, according to a June 6 memo signed by Medicaid Deputy Director Sara Vitolo that was obtained by the AP. The memo was written by several CMS officials under Vitolo's supervision, according to sources familiar with the process.

The data includes addresses, names, social security numbers, and claims data for enrollees in those states, according to the memo and two people familiar with what the states sent to CMS. Both individuals spoke on the condition of anonymity because they were not authorized to share details about the data exchange.

CMS officials attempted to fight the data sharing request from DHS, saying that to do so would violate federal laws, including the Social Security Act and the Privacy Act of 1974, according to Vitolo's memo.

"Multiple federal statutory and regulatory authorities do not permit CMS to share this information with entities outside of CMS," Vitolo wrote, further explaining that the sharing of such personal data is only allowed for directly administering the Medicaid program.

Sharing information about Medicaid applicants or enrollees with DHS officials would violate a "longstanding policy," wrote Vitolo, a career employee, to Trump appointee Kim Brandt, deputy administrator and chief operating officer of CMS.

Vitolo and Brandt could not be reached for comment.

The legal arguments outlined in the memo were not persuasive to Trump appointees at HHS, which oversees the Medicaid agency.

Four days after the memo was sent, on June 10, HHS officials directed the transfer of "the data to DHS by 5:30 ET today," according to email exchanges obtained by AP.

Former government officials said the move was unusual because CMS, which has access to personal health data for nearly half of the country, does not typically share such sensitive information with other departments.

"DHS has no role in anything related to Medicaid," said Jeffrey Grant, a former career employee at CMS.

Beyond her legal arguments, Vitolo said sharing the information with DHS could have a chilling effect on states, perhaps prompting them to withhold information. States, she added, needed to guard against the "legal risk" they were taking by giving federal officials data that could be shared with deportation officials.

A 'Concerning' Development

All states must legally provide emergency Medicaid services to non-U.S. citizens, including to those who are lawfully present but have not yet met a 5-year wait to apply for Medicaid.

Seven states, along with the District of Columbia, allow immigrants who are not living legally in the country to enroll -- with full benefits -- in their state's Medicaid program. The states launched these programs during the Biden administration and said they would not bill the federal government to cover those immigrants' healthcare costs.

The Trump administration has raised doubts about that pledge.

Nixon, the HHS spokesman, said that the state's Medicaid programs for immigrants "opened the floodgates for illegal immigrants to exploit Medicaid -- and forced hardworking Americans to foot the bill."

All of the states -- California, New York, Washington, Oregon, Illinois, Minnesota, and Colorado -- have Democratic governors. Due to his state's budget woes, Newsom announced earlier this year he would freeze enrollment into the program; Illinois will also shut down its program for roughly 30,000 non-U.S. citizens in July.

The remaining states -- New York, Oregon, Minnesota, and Colorado -- have not yet submitted the identifiable data to CMS as part of the review, according to a public health official who has reviewed CMS' requests to the states.

State health officials from the District of Columbia, Washington, and Illinois did not respond to requests for comment.

Newsom's office said in its statement that the data sharing has "implications for all Californians, but it is especially concerning for vulnerable communities."

https://www.medpagetoday.com/publichealthpolicy/medicaid/116070

Swearing Off Cold Drinks to Prevent Afib

 

• People reporting cold drinks or foods as triggers for their atrial fibrillation (Afib) were invited to a survey.
• Approximately half the cohort reported reducing their Afib episodes by avoiding cold ingestion, with methods including waiting for drinks to warm to room temperature and eliminating straw use.
• Healthcare providers often held a dismissive attitude towards the so-called "cold drink heart" phenomenon, the study showed.

Avoiding ice water, smoothies, and ice cream seemed to work as a lifestyle change for some with atrial fibrillation (Afib or AF), according to the first cross-sectional survey of people with "cold drink heart" (CDH).

Among people who claimed to have ever had symptomatic Afib triggered by cold ingestion, 51.5% reported that their Afib episodes occurred only following cold drink or food consumption (as opposed to other triggers). In these patients, avoidance of cold ingestion reduced or eliminated their Afib episodes with 100% effectiveness (as opposed to 72.4% in people who also had a history of non-CDH Afib).

"When asked about avoidance, respondents reported several effective behavioral modifications in lieu of complete avoidance, such as reducing speed of ingestion or avoiding rapid gulping, eliminating straw use, allowing drinks to warm to room temperature, or warming liquids in their mouth before swallowing," reported David Vinson, MD, of Kaiser Permanente (KP) Northern California in Pleasanton, and colleagues in the Journal of Cardiovascular Electrophysiologyopens in a new tab or window.

With their survey, the investigators had taken the first step to study the cold drink-Afib link more systematically, beyond the initial case reports.

The survey included 101 people who self-reported cold ingestion-triggered symptomatic Afib or atrial flutter at KP Northern California emergency departments (n=39) and an additional cohort of non-KP patients who had contacted the research team, unsolicited, offering their experience with CDH (n=62).

"We did this study because for decades there have been people telling their healthcare providers that cold foods and drinks trigger their atrial fibrillation episodes -- but many providers have dismissed this possibility," said Vinson in a press release. "Yet, the more patients with atrial fibrillation are asked about -- or read about -- this trigger, the more often we hear, 'Yes, that's happening to me, too.'"

"Although the majority of the people we surveyed said their atrial fibrillation was associated with cold ingestion, it was actually rare that eating or drinking something cold always precipitated an atrial fibrillation episode," Vinson noted. "In other words, most people with cold drink heart were often able to eat cold food or drinks without developing symptoms of atrial fibrillation. This shows how unpredictable the condition can be and why it's been hard for some patients to identify these triggers."

He and his study co-authors urged greater clinician awareness of CDH in the setting of Afib, citing one estimate that 5-10% of people with paroxysmal Afib may have cold drinks or foods as a trigger.

In their present report, patients said they had gotten a range of reactions from professionals when they shared their experiences: 52.4% of respondents reported dismissive attitudes from one or more healthcare providers, while some actually said they learned about the phenomenon from a physician.

In practice and in research, alcohol is more established as a dietary trigger of Afib.

"Alcohol ingestion has been recently identified as a trigger of discrete AF events, but only after a delay of 3-12 [hours]. This hours‐long delay contrasts with the relative immediacy of cold drink triggers, which precipitate AF within seconds to minutes," wrote Vinson's group.

Vinson and colleagues recruited a study cohort that was 75% men with a median age of 56 years, a median CHA₂DS₂‐VASc score of 1, and 25.7% on anticoagulants. Patients said they had been 44.5 years old at CDH onset.

When asked which rhythm was triggered by cold ingestion, 74.3% of patients reported only Afib, 15.8% said both Afib and flutter, 3.0% flutter only, while 7.0% said they were unsure.

The KP cohort underwent chart review for ECG confirmation of their Afib. As for the outside cohort, a documented diagnosis of AF or atrial flutter was required but these patients did not have to share their medical records.

Study authors noted that 36.5% of those surveyed reported that Afib was often triggered by cold ingestion soon after physical activity, and some reported that this was always the case for their CDH episodes.

"While the underlying mechanism could not be elucidated by the current study, an exacerbation after exercise suggests a vagotonic effect. Indeed, heightened vagal tone appears to trigger AF, and esophageal stimulation such as with a cold drink, may acutely increase such an autonomic response," Vinson's group surmised.

"Alternatively, as the esophagus lies directly behind and often in contact with the posterior left atrium, direct cold mechanical irritation of the left atrium may also be responsible, which also could be exacerbated post-exercise due to the relative increase in vagal tone," the investigators continued.

Rapid gulping or swallowing was reportedly also more likely to provoke Afib, the survey found.

Vinson and colleagues acknowledged that the study was not designed to prove causality and that the survey responses may have been inaccurate. There was likely some degree of selection bias affecting the study, as well.

"Further study will be required to assess the prevalence of CDH among an unselected population of AF patients, and importantly, the generalizability of our findings around the effectiveness of cold drink avoidance and other behavioral modifications in reducing AF recurrence," they wrote.

Disclosures

The study was supported by The Permanente Medical Group Delivery Science and Applied Research program.

Vinson had no personal disclosures.

One study co-author reported funding from the NIH and PCORI and personal ties to InCarda.

Primary Source

Journal of Cardiovascular Electrophysiology

Source Reference: opens in a new tab or windowDiLena DD, et al "Characterizing patients with cold drink-triggered atrial fibrillation" J Cardiovasc Electrophysiol 2025; DOI: 10.1111/jce.16753.

https://www.medpagetoday.com/cardiology/arrhythmias/116072

Zap the Skull to Treat Rheumatoid Arthritis Pain?

 Rheumatoid arthritis (RA) patients saw significant reductions in pain with transcranial direct current stimulation (tDCS) delivered at home, a sham-controlled trial reported here indicated.

After 4 weeks of treatment, patients receiving active stimulation showed reductions from baseline in self-reported pain averaging 33.5 points on a 100-point scale, compared with a 14.1-point decline among patients using the same device but inactivated, according to Stephanie Pilotti, MSc, of Universidade Federal do Rio Grande do Sul in Porto Alegre, Brazil.

The difference of 19.4 points was significant (P=0.003), Pilotti told attendees at the European Alliance of Associations for Rheumatology annual meetingopens in a new tab or window.

RA may be an inflammatory joint disease, but pain is still transmitted through the nervous system and thus may be amenable to neurological interventions. Pilotti observed that numerous studies in animal models and humans have established that when pain signalling becomes chronic, plasticity in the central nervous system (CNS) can, over time, alter how these signals are processed. Pain may be amplified and sensitivity to pain can increase to the point of allodynia (interpreting normal touch sensations as painful). One study she cited found that RA patients develop this sort of central sensitization "even in the absence of active inflammation."

One non-drug approach to alleviating chronic pain has been tDCS. Some studies have found that it can relieve pain from fibromyalgiaopens in a new tab or window and a variety of other chronic pain statesopens in a new tab or window. The theory is that it normalizes pain signalling, Pilotti explained, without dulling sensation from genuinely injurious stimuli.

For the new study, her group enrolled 34 women with stable RA not marked by extreme inflammation, randomizing them in equal numbers to active or sham therapy. Eligibility criteria included rating their pain at 40 or higher out of 100. Patients for whom tDCS would be contraindicated (those with epilepsy or cranial metallic implants, for example) were excluded, as were those with concomitant rheumatologic conditions.

Patient age averaged about 56, with a median RA duration of 10 years. Mean 28-joint Disease Activity Score values were just over 2.8. They rated their pain as fairly severe: averaging 72 points in the group randomized to active tDCS and 63 in the sham-treated control group.

The tDCS device resembled a cloth helmet. Patients were instructed to put it on for 20-minute sessions once a day for 5 days each week for 4 weeks; they were supervised remotely, however. Active treatment consisted of 2 mA of current. In the control group, some current was delivered briefly at the beginning and end of each session in an effort to maintain blinding.

In addition to rating their pain, patients also completed other self-evaluations, including their use of analgesic drugs (days/week). Blood samples were taken as well to measure RA and inflammation markers, plus brain-derived neurotrophic factor (BDNF) to get an objective look at CNS responses to treatment.

At the 4-week evaluation, weekly analgesic use had fallen by 2.3 days with active treatment versus a 1.4-day decrease among controls (P=0.025). No significant change was seen in maximum pain pressure threshold, but the minimum threshold rose by 1.0 kg/cm² in the active treatment group versus an increase of 0.4 kg/cm² in the sham group (P=0.003).

Changes in other measures, such as physical function, fatigue, and sleep quality, did not differ significantly between active and sham treatment. Nor were there any between-group differences in RA-related markers including tumor necrosis factor, interleukin-1, or interleukin-6. However, mean BDNF levels rose with active treatment while it declined in the sham group (P=0.002).

Pilotti and colleagues also checked in with participants 3 months after completing the 4-week program to have them rate their pain. It rebounded from the immediate post-treatment levels in both groups and the between-group difference was no longer significant; the absolute means remained below baseline, however.

Active treatment did not appear to induce more adverse events such as headache, scalp pain, itching, insomnia, and trouble concentrating relative to sham therapy. No severe problems occurred in either group, and all patients completed the 4-week treatment.

"This approach may represent a valuable adjuvant to the management of chronic pain in RA patients," Pilotti concluded.

Disclosures

No external funding for the study was reported.

Pilotti and other authors declared they had no relevant financial interests.

Primary Source

European Alliance of Associations for Rheumatology

Source Reference: opens in a new tab or windowPilotti S, et al "Effect of home-based transcranial direct current stimulation on pain in rheumatoid arthritis patients with low inflammatory activity: a randomized, double-blind, sham-controlled clinical trial" EULAR 2025; Abstract OP0280.

https://www.medpagetoday.com/meetingcoverage/eular/116074

Cancer Care Advocates in D.C. Ask Congress to Protect Independent Community Oncology

 Patients, Survivors, and Care Providers Meet with Lawmakers on Issues of Affordability and Care Access

More than 100 advocates from 23 states are assembling on Capitol Hill today to meet with their members of Congress and ask for support of independent community oncology. The advocates, including patients, survivors and their family members, oncologists, hematologists, pharmacists and pharmacy team members, and practice administrators, are gathering under the banner of the Community Oncology Alliance (COA) and asking members of Congress to implement policy fixes that increase the affordability of treatment, remove obstacles to care, and ensure practice longevity so future patients have easy access to care. COA and its advocates are holding almost 100 meetings with members of Congress and their staff.

While on the Hill, advocates are asking Congress to prioritize three goals:

1. Increase Patient Affordability. Differences in payments to hospitals versus independent practices and abuse of the 340B Drug Pricing Program are raising costs for patients. Advocates are asking Congress to pass site-neutral payment legislation and reform the 340B Program.
2. Remove Patient Access Obstacles. Insurers and middlemen, like pharmacy benefit managers (PBMs), are instituting unnecessary obstacles to cancer care, and the Centers for Medicare & Medicaid Services has banned medication delivery. Advocates are asking for reform of the prior authorization system, the passage of PBM reform, and the passage of the Seniors’ Access to Critical Medications Act (H.R. 2484) to allow patients with cancer to receive critical drugs through the mail.
3. Ensure Patient Access. For too long, practices have faced Medicare payments that do not keep up with inflation due to fee schedule cuts and outdated policies, making it harder to keep their doors open. Additionally, the Inflation Reduction Act (IRA) has put providers in the middle between drug manufacturers and the government drug price negotiations which threatens to dramatically cut reimbursement. COA advocates are asking Congress to address low physician payments and ensure they do not fall behind inflation. They’re also asking for a technical fix to the IRA that takes providers out of the negotiation process, removing them from harm’s way.

“All patients deserve access to local, high-quality, and affordable cancer care. Unfortunately, current policies make this reality more out of reach than ever,” says Nicolas Ferreyros, managing director of COA. “We must address abusive middlemen like PBMs, reimbursement rates that have not even keep up with inflation, and misguided public policy to move the needle for America’s patients. As cancer treatments advance, there is more hope than ever for patients battling cancer. To make this hope accessible for all, we must protect independent community oncology and the policies that support it.”

https://mycoa.communityoncology.org/news-updates/press-releases/june-2025-hill-day-press-release

'AI scientist’ suggests combinations of widely available non-cancer drugs can kill cancer cells'

 An ‘AI scientist’, working in collaboration with human scientists, has found that combinations of cheap and safe drugs – used to treat conditions such as high cholesterol and alcohol dependence – could also be effective at treating cancer, a promising new approach to drug discovery.

The research team, led by the University of Cambridge, used the GPT-4 large language model (LLM) to identify hidden patterns buried in the mountains of scientific literature to identify potential new cancer drugs.

To test their approach, the researchers prompted GPT-4 to identify potential new drug combinations that could have a significant impact on a breast cancer cell line commonly used in medical research. They instructed it to avoid standard cancer drugs, identify drugs that would attack cancer cells while not harming healthy cells, and prioritise drugs that were affordable and approved by regulators.

The drug combinations suggested by GPT-4 were then tested by human scientists, both in combination and individually, to measure their effectiveness against breast cancer cells.

In the first lab-based test, three of the 12 drug combinations suggested by GPT-4 worked better than current breast cancer drugs. The LLM then learned from these tests and suggested a further four combinations, three of which also showed promising results.

The results, reported in the Journal of the Royal Society Interface, represent the first instance of a closed-loop system where experimental results guided an LLM, and LLM outputs – interpreted by human scientists – guided further experiments. The researchers say that tools such as LLMs are not a replacement for scientists, but could instead be supervised AI researchers, with the ability to originate, adapt and accelerate discovery in areas like cancer research.

Often, LLMs such as GPT-4 return results that aren’t true, known as hallucinations. However, in scientific research, hallucinations can sometimes be beneficial if they lead to new ideas that are worth testing.

“Supervised LLMs offer a scalable, imaginative layer of scientific exploration, and can help us as human scientists explore new paths that we hadn’t thought of before,” said Professor Ross King from Cambridge’s Department of Chemical Engineering and Biotechnology, who led the research. “This can be useful in areas such as drug discovery, where there are many thousands of compounds to search through.”

Based on the prompts provided by the human scientists, GPT-4 selected drugs based on the interplay between biological reasoning and hidden patterns in the scientific literature.

“This is not automation replacing scientists, but a new kind of collaboration,” said co-author Dr Hector Zenil from King’s College London. “Guided by expert prompts and experimental feedback, the AI functioned like a tireless research partner—rapidly navigating an immense hypothesis space and proposing ideas that would take humans alone far longer to reach.”

The hallucinations – normally viewed as flaws – became a feature, generating unconventional combinations worth testing and validating in the lab. The human scientists inspected the mechanistic reasons the LLM found to suggest these combinations in the first place, feeding the system back and forth in multiple iterations.

By exploring subtle synergies and overlooked pathways, GPT-4 helped identify six promising drug pairs, all tested through lab experiments. Among the combinations, simvastatin (commonly used to lower cholesterol) and disulfiram (used in alcohol dependence) stood out against breast cancer cells. Some of these combinations show potential for further research in therapeutic repurposing.

These drugs, while not traditionally associated with cancer care, could be potential cancer treatments, although they would first have to go through extensive clinical trials.

“This study demonstrates how AI can be woven directly into the iterative loop of scientific discovery, enabling adaptive, data-informed hypothesis generation and validation in real time,” said Zenil.

“The capacity of supervised LLMs to propose hypotheses across disciplines, incorporate prior results, and collaborate across iterations marks a new frontier in scientific research,” said King. “An AI scientist is no longer a metaphor without experimental validation: it can now be a collaborator in the scientific process.”

The research was supported in part by the Alice Wallenberg Foundation and the UK Engineering and Physical Sciences Research Council (EPSRC).

Reference:
Abbi Abdel-Rehim et al. ‘Scientific Hypothesis Generation by Large Language Models: Laboratory Validation in Breast Cancer Treatment.’ Journal of the Royal Society Interface (2025). DOI: 10.1098/rsif.2024.0674

https://www.cam.ac.uk/research/news/ai-scientist-suggests-combinations-of-widely-available-non-cancer-drugs-can-kill-cancer-cells

Cardiac Effects of Modern Breast Radiation Therapy

Eva Berlin, Kyunga Ko, Lin Ma, Ian Messing,Casey Hollawell, Amanda M. Smith, Neil K. Taunk, Vivek Narayan, Jenica N. Upshaw, Amy S. Clark,  Payal D. Shah, Hayley Knollman, Saveri Bhattacharya, 
Daniel Koropeckyj-Cox, Jessica Wang

Abstract

Background

Radiation therapy (RT) improves breast cancer outcomes, but cardiac morbidity remains a concern.

Objectives

This study sought to evaluate changes in cardiac function after RT and the relationship between cardiac dose metrics and echocardiography-derived measures of function.

Methods

In a longitudinal cohort study of women with breast cancer, radiation cardiac dose metrics and core lab quantitated echocardiographic measures of cardiac function were evaluated. Dose metrics included the whole heart, left ventricle, right ventricle, and left anterior descending artery (LAD). Echocardiographic measures included left ventricular ejection fraction (LVEF), longitudinal strain, circumferential strain, E/e’ (ratio of early diastolic mitral inflow velocity to early diastolic mitral annular tissue velocity), Ea/Es (ventricular arterial coupling; ratio of effective arterial elastance to end systolic elastance), and right ventricular fractional area change. The mean change in echocardiographic measures over time and the association between cardiac dose metrics and echocardiographic measures were estimated by repeated-measures multivariable linear regression via generalized estimating equations.

Results

The cohort included 303 participants (median age 52 years, 33.3% African American) who received adjuvant RT (2010-2019) with a median mean heart dose of 1.19 Gy (Q1-Q3: 0.75-2.61 Gy), were followed over a median of 5.1 years (Q1-Q3: 3.2-7.1 years). Across all participants, there was a modest increase in LVEF (52.1% pre-RT to 54.3% at 5 years; P < 0.001) but a worsening in sensitive measures of function, such as circumferential strain (−23.7% pre-RT to −21.0% at 5 years; P = 0.003). Among left-sided/bilateral breast cancer participants, changes in cardiac function were observed across all parameters (P < 0.05). The maximum LAD dose was associated with a modest worsening in LVEF, longitudinal strain, circumferential strain, and E/e′.

Conclusions

Over a median of 5.1 years, modest changes in cardiac function were observed with RT. Maximum LAD dose was associated with a worsening in systolic and diastolic function parameters.

https://www.jacc.org/doi/10.1016/j.jaccao.2025.01.012

Cancer Patients Get Lost in the Red Tape of Utilization Management

 Utilization management (UM) is a set of insurance practices used to control costs by managing when, how, and whether certain treatments are approved. But for people with cancer, these practices can cause more harm than help.

The Insurance Maze: How Cancer Patients Get Lost in the Red Tape of Utilization Management reveals the real-world impact of UM across different insurance types—Employer Plans, Medicare Advantage, and Traditional Medicare.

Drawing on a national survey of 1,201 people treated for cancer, the report shows that insurance red tape is widespread and can delay diagnosis and treatment, impose administrative burdens, lead to unexpected costs, and erode trust in the healthcare system.

---

Our report highlights how insurance red tape can impact people with cancer:

• 85% faced prior authorization for cancer treatments, 76% in the last year alone, often multiple times.
• 43% of Employer Plan respondents underwent prior authorization for five or more different types of cancer treatments in the last year.
• 29% reported diagnosis delays; 40% reported treatment delays due to authorizations.
• 14% experienced abrupt coverage stoppages in the past year; 64% of those experienced treatment interruption.
• Among those who dealt directly prior authorization, 51% lost up to a full business day, 27% lost up to 2-3 business days, and 12% lost a full business week or more dealing with a single authorization incident.
• 95% of prior authorization requests were ultimately approved, highlighting the inefficient and overly broad use of UM in cancer care.
• 36% reported worsened stress, 34% reported worsened finances, and 29% reported reduced trust in the healthcare system as a direct result of insurance problems.
• Respondents with Employer Plans reported the most administrative burden and greatest red tape impacts, followed by Medicare Advantage, then Traditional Medicare.

The results of this report make it clear that many people with cancer face insurance red tape and administrative inefficiencies that obstruct access to timely, high-quality care. UM and other cost-containment strategies must be designed to support, not delay or deny, affordable cancer treatment. Reforming these systems is essential to reducing burden in patients, improving outcomes, and ensuring that administrative processes facilitate, rather than hinder, care. Policymakers, insurers, employers, and advocates must collaborate to streamline UM processes, increase transparency, and prioritize person-centered care, allowing patients to focus on recovery, not red tape.

This report provides a robust, patient-informed snapshot of the current challenges in accessing cancer care. The findings can guide: policymakers seeking data to support insurance reform; insurers, pharmacy benefit managers, and payors aiming to improve coverage practices; employers evaluating benefit designs; researchers exploring the human impact of insurance barriers; and journalists reporting on healthcare access, policy and equity.

https://www.cancercare.org/redtape