Changes in Uninsured Status Among Nonelderly Cancer Patients Under the Affordable Care Act

Key Points

  • After institution of the Affordable Care Act, uninsured status declined by an absolute 1.92% and a relative 33.5%.
  • Groups with the greatest declines included those with distant disease, those with lung or bronchial cancer, and Hispanic patients.

In a research letter in JAMA Oncology, Soni et al reported reductions in the proportion of nonelderly adult cancer patients who were uninsured between 2010 and 2013 vs 2014, after institution of the Affordable Care Act (ACA).

Study Details

The study used data from the Surveillance, Epidemiology, and End Results (SEER) program on 858,193 patients aged 19 to 64 years with a new cancer diagnosis between 2010 and 2014. Among them, 55% were women, and the mean age was 52 years.

Reductions in Uninsured Status

For 2010–2013 vs 2014, 5.73% vs 3.81% of patients were uninsured (1.92% absolute reduction; 33.5% relative reduction, P < .001). Significant reductions in uninsured status were found across all disease stages and sites.

The greatest absolute declines were for distant disease (9.11% vs 6.08%, 3.03% reduction), lung or bronchial cancer (9.03% vs 6.03%, 2.95% reduction), colorectal cancer (7.85% vs 5.20%, 2.65% reduction), and regional disease (6.03% vs 3.93%, 2.65% reduction). For demographic characteristics, the largest absolute declines were for Hispanic patients (9.58% vs 5.75%, 3.82% reduction) and patients from wealthier counties (above the median poverty rate; 7.53% vs 4.81%, 2.72% reduction).

The investigators concluded: “Uninsurance among patients with newly diagnosed cancer fell by one-third in the ACA’s first year. Coverage gains were significant across numerous common cancers, multiple demographic groups, and early-stage and late-stage disease. Large gains among Hispanic individuals were consistent with findings of other ACA studies.”

The study was supported by the National Cancer Institute and Office of Behavioral and Social Sciences Research and by the Agency for Healthcare Research and Quality.

Aparna Soni, MA, of Kelley School of Business, Indiana University, Bloomington, is the corresponding author of the JAMA 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®.


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