Xuesong Han, Strategic Director, Health Policy & Healthcare Delivery Research, American Cancer Society
With millions of Americans gaining insurance through the Affordable Care Act, we can expect to see a change in the distribution of insurance status among cancer patients. For example, a recent study published in Cancer (Parsons 2016) identified an increase in the rate of young adult cancer patients with private insurance following the implementation of the ACA dependent care provision in 2010. With the full implementation of the ACA expanding Medicaid eligibility in more than half of the states and creating marketplaces nationwide in 2014, I expect to see an increase in Medicaid and private insurance coverage, along with a decrease in uninsured rate, among cancer patients.
Whether this increase in insurance rate translates to increased access to cancer care and improved cancer outcomes remains to be seen and is important to monitor for cancer control. In the coming years, I would not be surprised if we see an increase in cancer screening uptake and a shift to earlier stage of cancer diagnosis, more cancer patients being able to receive timely treatment, and eventually improved survival and quality of life, especially among those with a low- to medium-income and residing in the states that adopted Medicaid expansion. As a result, we may see a narrowing of the disparities in cancer outcomes by race/ethnicity and socioeconomic status in the coming years.
The Affordable Care Act and Cancer Stage at Diagnosis Among Young Adults (The abstract below is from JNCI Journal of the National Cancer Instititute)
The Affordable Care Act-dependent coverage expansion provision implemented in 2010 allows young adults to be covered under their parents’ health insurance until age 26 years, and millions of young adults have gained insurance as a result. The impact of this policy on cancer patients has yet to be determined. Using 2007 to 2012 data from 18 registries of the Surveillance, Epidemiology, and End Results Program, comparing cancer patients age 19 to 25 years to a control group of patients age 26 to 34 years who were not affected by the provision, we observed a 2.0 (95% confidence interval [CI] = 0.7 to 3.4) percentage point decrease in uninsured rate and a 2.7 (95% CI = 0.6 to 4.8) percentage point increase in diagnosis at stage I disease for patients age 19-25 years. Further analyses by specific cancer site revealed that the statistically significant shifts were confined to carcinoma of cervix (21.2, 95% CI = 9.6 to 32.7 percentage points) and osseous and chondromatous neoplasms (14.4, 95% CI = 0.3 to 28.5 percentage points), which are detectable by either screening or clinical manifestation. These early observations suggest the policy has had positive benefits in cancer outcomes.
The opinions expressed in this article are those of the authors and may not represent the official positions of NAACCR.