"Patients may have fewer choices of doctors and hospitals in some exchange plans than others ... but the rules for such plans go a long way toward remedying the most severe problems that existed for decades," said Steve Weiss, spokesman for the American Cancer Society Cancer Action Network.
The new obstacles are more subtle.
To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans.
By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere.
For now, the issue seems to be limited to the new insurance exchanges. But it could become a concern for Americans with job-based coverage too if employers turn to narrow networks.
The AP surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network. Two additional institutions that joined this week were not included in the survey.
Cancer network members are leading hospitals that combine the latest clinical research and knowledge with a multidisciplinary approach to patient care. They say that patients in their care have better-than-average survival rates. The unique role of cancer centers is recognized under Medicare. Several are exempt from its hospital payment system, instituted to control costs.
The AP asked the centers how many insurance companies in their state's exchange included them as a network provider.
Of the 19 that responded, four reported access through all insurers: the Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore; Fox Chase Cancer Center in Philadelphia; Duke Cancer Institute in Durham, N.C.; and Vanderbilt-Ingram Cancer Center in Nashville, Tenn. One caveat: Some insurers did not include these cancer centers on certain low-cost plans.