Early in 2020, Ella Nelson was 2 years old when her grandmother noticed a small lump on the right side of her abdomen. Finding that lump was the start of a difficult years-long odyssey for Ella, her mother, Megan, and her father, Marcus.
Three weeks earlier, Megan Nelson had just given birth to Ella’s brother, Francis. At the time, Megan and Marcus were serving in the military, relying on Cardinal Care, Virginia’s Medicaid program, to cover Ella and Francis’ treatment costs. Megan was an assistant professor of military science in the ROTC Department at the Virginia Military Institute, and Marcus was a company commander stationed at Fort Lee. Knowing Medicaid would cover Ella’s care, they took her to a local hospital in Virginia that Megan did not wish to name after physicians misdiagnosed Ella’s condition as Wilms tumor.
Surgery to remove the tumor and a kidney is the standard protocol for a child with Wilms tumor, according to the University of Michigan. Following surgery, a pathology report showed Ella had a different form of cancer: stage 4 neuroblastoma, Megan explained.
Why Ella’s story is important now
That missed diagnosis and the mistaken removal of a kidney led Megan and Marcus to look nationwide for the best hospitals. Their search ended at the safety-net Children’s Hospital Los Angeles (CHLA) on Sunset Boulevard in Los Angeles where surgeons and staff cared for Ella over the next two years, often for weeks at a time, Megan said. CHLA is ranked among the nation’s best children’s hospitals, according to the 2025-2026 rankings in the U.S. News and World Report.
The staff at CHLA, including Araz Marachelian, M.D., the medical director of the Neuroblastoma MIBG Program, provided excellent cutting-edge care to Ella in the hospital’s Cancer and Blood Disease Institute, Megan Nelson said. In addition, the family did not suffer the crippling financial burden that accompanies any long-term hospital stay, she added. Today, Ella is age 7 and has had no evidence of disease since 2021, Megan Nelson said by email on Jan. 4.
In May, Megan Nelson told this story during AHCJ’s annual conference in Los Angeles. In a follow-up phone interview, she provided more details. While Megan Nelson was speaking that day in L.A., Congress was debating the budget megabill that will cut $1 trillion in funding over 10 years from Medicaid, Medicare, SNAP and other programs, as KFF reported. When the budget bill became law on July 4, AHCJ reported on it here and here.
Covering financial toxicity
During her remarks, Megan Nelson made a point to highlight the fact that the family did not experience financial toxicity because Medicaid in California, called Medi-Cal, is a public health insurance program for low-income families. A combination of Medi-Cal and funding from California Children’s Services (CCS) covered the costs of Ella’s care, Megan Nelson said.
“We just knew we qualified for Medi-Cal and that we also had CCS. Beyond that, I honestly don’t know [all the financial] details,” Megan Nelson added. “I just know we didn’t have to pay anything out of pocket, which is great.”
For journalists, the Nelson family’s experience leads to multiple questions reporters will need to address starting this year and continuing through the next decade, such as these:
- How will families pay for health care without Medicaid?
- How will hospital charity care programs respond when fewer patients can enroll in Medicaid?
- Will states limit payments to patients needing long-term care for cancer, heart disease or other serious diagnoses?
- Will more patients become homeless if they cannot afford housing because they can’t pay for health insurance or care?
- Will more patients with serious conditions die because of depression, suicide, malnutrition, lack of housing or other causes?
- Will hospitals and physicians turn away patients who have unpaid medical debt?
- Will hospitals, physicians and other providers struggle to deliver care when many Americans cannot pay their bills?
- How will young families pay for the care of any child with a costly illness?
A stark contrast
The Nelsons’ experience at CHLA stands in stark contrast to what other families confront when a child or any family member has a long-term illness.
For parents with children who have cancer, the costs of care can be financially crippling, said Gwen Nichols, M.D., the executive vice president and chief medical officer for Blood Cancer United (BCU). Formerly the Leukemia & Lymphoma Society, BCU is a nonprofit organization that supports blood cancer patients, research and advocacy.
“About 50% of children with cancer require Medicaid at some point in their cancer treatment,” Nichols added. “Those families need to add Medicaid on [as insurance coverage], or they need to move completely to Medicaid, because they use up all their resources, and their insurance won’t be adequate.
“This is not entirely surprising, because young adults have young children, and so these people often are not established in their careers and don’t have big nest eggs they can count on,” she explained.
“I worry about what we’re going to see because already more people call us who have cancer and are homeless and have had to delay treatment,” Nichols said. “We all know, the sooner you treat cancer, the better chance of cure.”
Health insurance equals better outcomes
Nichols explained some of the challenges the uninsured and underinsured face. “Families will do anything, as any of us would, to keep their child alive,” Nichols said. “But the debt that accrues affects multiple generations. Your other kids don’t go to college because one parent has to quit work, meaning you’re living on a single salary. A panoply of factors leave people desperate and crush young families.”
BCU-supported research shows that continuous Medicaid coverage can increase the chances of survival for pediatric, adolescent and young-adult patients diagnosed with blood cancer, the researchers wrote in an article published in September 2024. But, they added, fewer than half of such patients with Medicaid have had continuous coverage before diagnosis.
Nichols’ colleague, Nikki Yuill, is the director of BCU’s Information Resource Center for blood cancer patients who need help finding treatment and overcoming financial barriers to care. “The unaffordability of health care and rising levels of medical debt are changing the lives of cancer patients,” Yuill said. “I have never seen this level of financial toxicity and medical debt across all demographics and ages. Whether urban or rural, patients are not okay.
“We’re already getting calls from people who are scared and worried,” she added. “They’re suffering because they say they can’t afford their premiums and don’t know what’s going to happen next.”
Resources
- “Medical Debt in the US: Associations With Cancer Screening, Mortality, and Health Status,” Health Affairs, December 2025
- “The One Big Beautiful Bill Act (OBBBA) & Credit Reporting Rule–What You Need to Know,” Undue Medical Debt, July 25, 2025
- “Health insurance continuity and mortality in children, adolescents, and young adults with blood cancer,” The Journal of the National Cancer Institute, September 2024
- “Ella’s Story,” CHLA via You Tube, Sept. 24, 2024
- “A Lifesaving Move for Ella,” Sara Jones for CHLA, October 2022, updated, May 30, 2024
- “Medical Debt and Cancer,” American Cancer Society, Cancer Action Network, May 9, 2024
- “Nearly 1 in 2 Patients with Medical Debt Feel ‘Trapped,’ New Poll from Leading Healthcare Orgs Finds,” Blood Cancer United, Oct. 30, 2023
- “Paying for It: How Health Care Costs and Medical Debt Are Making Americans Sicker and Poorer,” The Commonwealth Fund, Oct. 26, 2023
- “New Research Shows Increased Medical Debt Associated with Significantly Higher Cancer Mortality Rates,” American Cancer Society, June 6, 2023
- In America, Cancer Patients Endure Debt on Top of Disease, Noam N. Levey, KFF Health News, July 9, 2022
