Changes in Insurance Coverage and Diagnosis Stage After Affordable Care Act Implementation

Key Points

  • The percentage of uninsured patients decreased after implementation of the ACA, especially among low-income patients in Medicaid expansion states.
  • Trends toward earlier diagnosis were observed for several cancers.

Jemal et al found decreases in the percentage of uninsured patients and trends toward earlier diagnosis among nonelderly patients with cancer after implementation of the Affordable Care Act (ACA). Their findings were reported in the Journal of Clinical Oncology.

Study Details

The study used National Cancer Data Base data to estimate the absolute percentage change (APC) and relative change in percent of uninsured patients among patients with newly diagnosed cancer aged 18 to 64 years from 2011 to the third quarter of 2013 (pre-ACA) and from the second to fourth quarter of 2014 (post-ACA) in Medicaid expansion and nonexpansion states according to family income level. Changes in insurance and early-stage diagnosis for the 15 leading solid cancers in men and women (top 17 cancers total) were also assessed.

Changes After ACA

In the post-ACA period, there was a decrease in the percent of uninsured patients among patients with newly diagnosed cancer in all income categories in both Medicaid expansion and nonexpansion states. The decrease was largest in low-income patients in Medicaid expansion states (9.6% to 3.6%, APC = –6.0%, 95% confidence interval [CI] = –6.5% to –5.5%); for low-income patients in nonexpansion states, the decrease was from 14.7% to 13.3% (APC = –1.4%, 95% CI = –2.0% to –0.7%).

The percentage of uninsured patients decreased significantly for all 17 cancers examined in both Medicaid expansion and nonexpansion states, with the decreases being greatest in Medicaid expansion states, low-income patients, and for smoking- or infection-related cancers. Small but statistically significant shifts to earlier diagnosis for colorectal, lung, female breast, and pancreatic cancers and melanoma were observed for patients in Medicaid expansion states.

The investigators concluded: “Percent uninsured among nonelderly patients with newly diagnosed cancer declined substantially after the ACA, especially among low-income people who resided in Medicaid expansion states. A trend toward early-stage diagnosis for select cancers in expansion states also was found. These results reinforce the importance of policies directed at providing affordable coverage to low-income, vulnerable populations.

The study was supported by the American Cancer Society.

Ahmedin Jemal, DVM, PhD, of the American Cancer Society, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


Advertisement

Advertisement



Advertisement