Investigators have uncovered that during the Patient Protection and Affordable Care Act’s (ACA) first decade, the survival rates of Dependent Coverage Expansion–eligible young adult patients with cancer may have improved, according to a recent study published by Roth et al in Cancer.
The federal ACA passed in 2010 and includes a Dependent Coverage Expansion provision permitting dependents to remain on their parents’ health insurance plans from age 19 to 25 years. This age group has historically had the highest uninsured rate in the United States.
Study Methods and Results
In the recent study, the investigators used cancer mortality data from the U.S. Centers for Disease Control and Prevention and cancer survival data from the Surveillance, Epidemiology, and End Results database—representing 42% to 44% of the United States—to examine whether young adult patients with cancer diagnoses benefited from the ACA’s Dependent Coverage Expansion.
The investigators then assessed changes in cancer survival and mortality pre- and post-ACA enactment in patients aged 19 to 25 years. They compared these trends with those among two age groups: patients aged 12 to 18 years and those aged 26 to 32 years.
The Dependent Coverage Expansion–eligible patients were the only age group among the three groups to experience improvements in both cancer survival and mortality rate trends following ACA implementation. Additionally, the inflection year for both survival and mortality in this group was 2010—the year the ACA was passed.
Following ACA enactment, the 6-year relative survival rate was 2.6- and 3.9-times greater in the Dependent Coverage Expansion–eligible age group compared with the younger and older age groups, respectively. In comparing post-ACA with pre-ACA cancer-related mortality rates from 2010 to 2021, within 12 years after ACA enactment, the Dependent Coverage Expansion–eligible group had the largest decrease: 2.1- and 1.5-times greater compared with the younger and older age groups, respectively.
Conclusions
“Within just 10 years after its passage, the [Dependent Coverage Expansion] has allowed young adults with cancer who were covered by it to live longer and [be] more likely [to] be cured. The [Dependent Coverage Expansion] and Medicaid should not only be continued but expanded to enable more [U.S. patients] to be diagnosed earlier, require less therapy, and, for those diagnosed later with their disease, to live longer and have higher cure rates,” emphasized senior study author Archie Bleyer, MD, of the Oregon Health & Science University. “Moreover, other serious physical or mental diseases are likely also having better outcomes since the ACA [Dependent Coverage Expansion] and should be similarly evaluated, which could strengthen the need even more for ACA and Medicaid coverage and expansion,” he concluded.
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
