Increased Insurance Coverage Seen Under the ACA for Patients With Cancer

Since the enactment of the Affordable Care Act (ACA), the number of uninsured individuals in the United States has reached a historic low. With the future of ACA questionable, many have asked the question of how changes to the act could affect the coverage of millions, especially those with preexisting conditions.

With cancer being the leading cause of death for those aged 19 to 64, a recent study in JAMA Oncology analyzed the changes in health insurance coverage under the ACA for patients newly diagnosed with the disease.

“Treatment for cancer is typically unaffordable for individuals without insurance, and several studies suggest that expanding insurance coverage would improve cancer-related outcomes,” wrote the authors.

The authors of the study collected data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. The program, a coordinated registry of patients with cancer in the United States, covers 28% of the population and is representative of national demographics. Authors focused on 858,193 adults aged 19 to 64 who were recently diagnosed with cancer for the first time.

Authors compared data from 2014, when ACA health insurance exchanges and Medicaid expansion went into effect, to data from pre-ACA years 2010 through 2013. They repeated the analysis classifying by tumor location for the 5 most common types of non-skin cancer, cancer stage, race/ethnicity, and county poverty rate.

Results showed that before 2014, 5.73% of these individuals were uninsured, and in 2014 3.81% were uninsured, representing a decrease of 1.92 percentage points. There were also substantial declines among all stages and sites analyzed. The biggest absolute declines were for distant disease (—3.03 percentage points) and lung and bronchial cancer (–2.95 percentage points). The relative declines for distant disease and lung and bronchial cancer were –33.26% and –32.67%, respectively.

In regard to demographic features, the greatest relative changes in uninsurance rates were seen among Hispanic patients (—39.87%) and patients of other race (–46.19%). Those living in wealthier counties (counties with an above-median poverty rate) had a relative change of –36.12%.

For Medicaid expansion status, the uninsured rate remained steady both prior to and after the enactment of the ACA for non-expansion states. Meanwhile, the percentage of uninsured patients declined significantly (by 2.4 percentage points) for expansion states after the ACA was enacted. This increased insurance rate suggests that the general increase in coverage from the ACA extends to this group of patients as well.

Overall, the uninsurance rate among patients with recently diagnosed cancer decreased by one-third. Insurance rates increased significantly for several common cancers, demographic groups, and early- and late-stage disease. The increasing rate of coverage among Hispanic individuals aligned with past ACA studies that have implied narrowing disparities in coverage status.

“Policy changes that reduce Medicaid funding or weaken protections for individuals with preexisting conditions could be particularly harmful for patients with cancer,” concluded the authors.