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Fewer newly diagnosed patients with cancer lack insurance after ACA

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October 19, 2017

Aparna Soni

Uninsurance rates among patients newly diagnosed with cancer dropped one-third during the Affordable Care Act’s first year of implementation, according to study results.

Since implementation of the ACA in 2014, the number of uninsured individuals has reached a historical low.

Because cancer treatment is often unaffordable for patients without insurance, research suggests expansion of insurance coverage may improve cancer-related outcomes.

Aparna Soni, MA, doctoral candidate in the business economics and public policy department of the Kelley School of Business at Indiana University Bloomington, and colleagues used SEER registry data to determine the number of patients uninsured at cancer diagnosis between 2010 and 2014. The researchers compared changes in health insurance coverage among patients newly diagnosed with cancer in 2014 — the year of the ACA health insurance exchanges and Medicaid expansion implementation — with those diagnosed between 2010 and 2013, prior to the ACA’s implementation.

Repeated analyses using Stata software version 14, called StataCorp, stratified results according to the five most common types of nonskin cancers — breast, prostate, colorectal, lung and bronchial, and thyroid cancers — cancer stage, race and ethnicity, and county poverty rate. The analysis included 858,193 adults (mean age, 52.4 years) with newly diagnosed cancer.

Prior to 2014, 5.7% of individuals lacked insurance. This rate dropped by 33.51% to 3.8% (95% CI, –2.02 to –1.81) in 2014.

Researchers observed this trend across cancer stages and types.

The largest absolute declines in uninsurance occurred for patients diagnosed with distant disease (–3.03 percentage points; 95% CI, –3.32 to –2.74) and lung and bronchial cancer (–2.95 percentage points; 95% CI, –3.44 to –2.46). However, researchers noted the relative declines for distant disease (–33.26%) and lung and bronchial cancer (–32.67%) appeared similar compared with the full sample (–33.51%).

Changes in insurance coverage appeared highest among Hispanics (relative change, –39.87%), individuals of other races (–46.19%) and residents of counties with poverty rate above the median (–36.12%).

Uninsured rates before and after 2014 did not change for states without Medicaid expansion.

Conversely, the uninsured rate sharply declined in 2014 for states with Medicaid expansion, for a difference-in-differences estimate of –2.4 percentage points (P = .007).

Limitations of the study included that data were only available from 13 states and for 1 year following the ACA’s implementation.

“Although we provide novel evidence that fewer patients newly diagnosed with cancer were uninsured in the post-ACA period, our analysis did not separate the effects of gains in coverage among patients who would have been diagnosed in the absence of the ACA from changes in the number of diagnoses resulting from increased coverage,” the researchers wrote. “Future research should examine effects of coverage on cancer diagnosis, treatment and outcomes.

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“Policy changes that reduce Medicaid funding or weaken protections for individuals with preexisting conditions could be particularly harmful for patients with cancer,” the researchers added. – by Melinda Stevens

Disclosures: The authors report no relevant financial disclosures.