Medicaid Cuts Create Barriers for Oncologists and Patients With Cancer
Gwen Nichols, MD, discussed the impact of Medicaid reductions on patient care and how oncologists can advocate for accessible cancer treatment during these uncertain times.
Gwen Nichols, MD
Medicaid reductions and delays in National Institutes of Health (NIH) research funding are posing significant challenges for cancer care, particularly affecting low-income patients and their providers.1,2
The NIH, the world’s largest public funder of biomedical research, is currently experiencing an indefinite freeze on payments due to procedural disruptions following the change in administration.2 This freeze has delayed critical grant-review meetings, halting the $47 billion annual budget and jeopardizing the development of new treatments for cancer.
Such proposed cuts to Medicaid threaten access to care for patients with cancer, including pediatric patients and young adults. According to the American Cancer Society Cancer Action Network, 1 in 3 pediatric patients with cancer rely on Medicaid to access essential treatments, medications, and supportive services without facing overwhelming costs.1 Additionally, oncologists in community settings, who depend on Medicaid to manage the high costs of care, may face difficult decisions about limiting or denying treatments.
The Leukemia & Lymphoma Society (LLS) has also raised alarm over these cuts, emphasizing that NIH funding is essential for advancing new treatments, and any disruption could delay progress.3 LLS is calling for a balanced approach to funding reductions, urging lawmakers to prioritize the stability of research funding and ensure continued access to life-saving care.
In an interview with Targeted OncologyTM, Gwen Nichols, MD, executive vice president and chief medical officer of LLS, discussed the impact of these challenges on patient care and how oncologists can advocate for accessible cancer treatment during these uncertain times.
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Targeted Oncology: How do Medicaid reductions affect oncologists’ ability to provide care for lower-income patients with cancer?
While NIH funding cuts present long-term challenges for research, Medicaid reductions have an immediate impact on patient care. Many people are unaware that 50% of children with cancer receive Medicaid support. Even families with private insurance often rely on Medicaid because of the high costs associated with treatment. Parents of young children with cancer are often early in their careers and lack the financial stability that older adults may have. If Medicaid becomes harder to access, these families will struggle to obtain life-saving treatments.
Another issue is the implementation of Medicaid work requirements. While addressing abuses in the system is important, requiring cancer patients to prove they are seeking work while undergoing treatment is unrealistic and inhumane. A five-year-old child with cancer or an adult undergoing intensive chemotherapy should not have to worry about work requirements to access care.
If Medicaid funding is restricted or work requirements are imposed indiscriminately, oncologists will face difficult choices. They may be forced to either deny treatment to patients who can’t afford it or offer suboptimal therapies. We have made remarkable progress in cancer treatment, but these advancements come at a cost. Without adequate coverage, patients who could otherwise be cured may be left without access to life-saving care.
These funding and policy changes will place significant strain on practicing oncologists, particularly those treating underserved populations. Ensuring access to Medicaid is critical for maintaining equitable cancer care.
Talking about Medicaid is really important. The proposed cuts are dramatic, and so many people rely on Medicaid for essential healthcare. It’s critical to help everyone understand the severity of these cuts and advocate against them—at least against the extent of them.
How might these policy changes impact community oncology centers' ability to provide cutting-edge treatments often pioneered in academic institutions?
There are 2 parts to that question. First, we may see a slowdown in the progress of new therapies due to both NIH funding cuts and reductions in federal support for institutions like the FDA. Second, Medicaid plays a key role in offsetting costs at the community level.
If a patient lacks Medicaid coverage, treatment decisions often come down to what they can afford rather than what is medically best. That’s not how it should be, but it is how our healthcare system works. If a doctor believes the best treatment is an expensive one but the patient can’t afford it, there’s only so much cost that community oncologists can absorb. Their practices cannot make up for a lack of Medicaid funding indefinitely. In the end, they may be unable to see these patients at all, which is devastating.
How might Medicaid reductions affect care coordination between community oncologists and larger academic institutions?
That depends on how the larger academic institutions provide care. If a patient doesn’t have Medicaid or any insurance, some bigger institutions may be able to offer charity care—but that’s much harder in smaller community settings.
My biggest concern is not just disrupted care coordination; it’s a complete lack of care. If patients lose coverage, they may not be able to find a facility willing or able to treat them.
Are there particular cancer patient populations that could face even greater barriers to treatment due to these funding changes?
Pediatric patients stand out the most. While Medicaid is important for all lower-income patients, it’s especially critical in childhood cancer. Around 50% of children with cancer rely on Medicaid. Parents will do anything to get their child treatment, but without Medicaid, they could face overwhelming medical debt—potentially jeopardizing the entire family’s well-being.
The financial strain isn’t just short-term; it has multi-generational consequences. Families might have to forgo other essential needs—like food, housing, or education for their other children—to afford cancer treatment.
For blood cancers, this is even more concerning. Leukemia is one of the most common childhood cancers, and we now cure more than 90% of children with acute lymphoblastic leukemia (ALL)—but only if they receive timely and proper treatment. That treatment is expensive and lasts years. Imagine being a single parent or having multiple children to care for while also dealing with cancer treatment costs. Medicaid is a lifeline for these families.
What about young adults with cancer?
Absolutely. Young adults are another highly vulnerable group. If you’re 28 and diagnosed with lymphoma, you likely expect to survive and live a long, healthy life—if you get the right treatment. But at 28, you’re no longer on your parents’ insurance. You’re early in your career, likely not making a high salary, and your employer-sponsored insurance may not be comprehensive. Many in this group rely on Medicaid, and if it’s cut, they may struggle to access life-saving treatment.
It’s deeply frustrating because these are the patients with the most to gain from treatment. They have decades of life ahead of them if we can get them the right care.
What strategies can oncologists use to help Medicaid patients navigate potential coverage gaps or financial hardships?
There are many great nonprofits, including the Leukemia & Lymphoma Society (LLS), that offer financial assistance, but the reality is that no nonprofit can fully cover the cost of cancer treatment. The financial burden is simply too great.
Oncologists should refer patients to resources like the LLS Information Resource Center (IRC), where families can get guidance on financial assistance programs. Our team is available at LLS.org or through our toll-free number.
Beyond that, we need to advocate for more targeted Medicaid cuts—ones that focus on eliminating fraud without harming the most vulnerable patients.
Given these challenges, how can academic and community oncologists work together to advocate for sustained funding and continued progress in cancer treatment?
My biggest recommendation is to get involved in advocacy. Join LLS Advocacy, ASCO Advocacy, ASH Advocacy—whatever professional organization aligns with your work.
Legislators need to understand the real impact of these cuts on patients. Oncologists, regardless of political affiliation, care about their patients. This isn’t about politics; it’s about ensuring that cancer patients—especially the most vulnerable—can access the care they need.
Advocating is easier than people think. You don’t have to travel to Washington, D.C., or state capitals. Through LLS Advocacy, for example, you can send messages to your representatives with the click of a button. It’s a simple but powerful way to make your voice heard.
REFERENCES:
Congressional budget cuts to Medicaid would harm cancer patients and their families. News release. American Cancer Society. February 12, 2025. Accessed February 20, 2025. https://tinyurl.com/48m7ut2r
Revealed: NIH research grants still frozen despite lawsuits challenging Trump order. News release. Nature. February 20, 2025. Accessed February 20, 2025. https://tinyurl.com/wd288yph
FAQS: proposed federal spending cuts and blood cancer research and care. News release. The Leukemia & Lymphoma Society. February 19, 2025. Accessed February 20, 2025. https://tinyurl.com/3sesftr9
