The Affordable Care Act and Expanded Insurance Eligibility Among Nonelderly Adult Cancer Survivors

Davidoff, Amy J.; Hill, Steven; Bernard, Didem; Yabroff, K. Robin

doi:10.1093/jnci/djv181

Cited by 43 publications

(57 citation statements)

References 25 publications

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“…Earlier reports have shown that survivors of cancer who are without insurance may find it difficult to use medical care compared with survivors who have insurance, especially due to cost reasons [44,45], which may explain lower quality ratings from uninsured survivors. As our assessment was prior to the rollout of major Patient Protection and Affordable Care Act (ACA) provisions [46] that expands insurance eligibility, it is likely that some of the issues reported by survivors may be reduced as more obtain insurance [47]. At the same time, an increasing number of survivors will have access to public insurance via Medicaid expansion, meaning that future studies must determine how the ACA has impacted health care experiences of this population.…”

Section: Discussionmentioning

confidence: 99%

Health care experiences of long-term survivors of adolescent and young adult cancer

Kaul

Fluchel

Parmeter

et al. 2016

Support Care Cancer

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Section: Discussionmentioning

confidence: 99%

Health care experiences of long-term survivors of adolescent and young adult cancer

Kaul

Fluchel

Parmeter

et al. 2016

Support Care Cancer

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“…18 In earlier assessments, uninsured survivors of AYA cancer reported skipping medical care more often than insured survivors, although dental care was not specifically investigated. 4 While the Affordable Care Act (ACA) is expected to enhance medical insurance availability for cancer survivors, 19 dental coverage is not part of the ACA's required essential health benefits, and Medicaid coverage of adult dental benefits varies state by state. 20 As a result, it is projected that the number of adults without dental benefits will only be reduced by a marginal 5% relative to 2010 figures.…”

Section: Introductionmentioning

confidence: 99%

Dental Care for Survivors of Adolescent and Young Adult Cancer: Special Considerations

Kaul

Fair

Wright

et al. 2016

Journal of Adolescent and Young Adult Oncology

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Purpose: Oral health is important for quality of life, but may be undermanaged for survivors of cancer. We examine dental care use and barriers among long-term survivors of adolescent and young adult (AYA) cancer in comparison to individuals without a history of cancer. Methods: The 2008-2012 Medical Expenditure Panel Survey (MEPS) identified 1216 individuals diagnosed with cancer at AYA ages (15-39 years), who were at least 5 years from diagnosis. A comparison group was matched using age, sex, and other factors. We evaluated self-reported dental visits in the previous 12 months , and inability and delay in receiving necessary dental care among survivors and the comparison group. Furthermore, individual factors associated with dental care use were identified using multivariable logistic regressions. Results: Of survivors, 60.86% reported no dental visits in the previous year compared to 51.96% of the comparison individuals ( p < 0.001). Survivors were more likely to report inability (10.71% vs. 6.29%, p = 0.001) and delay (8.12% vs. 4.45%, p = 0.001) in getting necessary dental care than the comparison group. Notably, survivors without dental insurance were more likely to report inability and delay. Female survivors were more likely to use dental care than males (odds ratio = 1.76, 95% confidence interval 1.15-2.71, p = 0.01). Hispanic survivors, those diagnosed at younger ages, and uninsured survivors were less likely to have at least one dental visit. Conclusion: Survivors of AYA cancer need timely surveillance to manage late effects, including dental complications. Yet, these survivors, particularly those who are uninsured, delay dental care more often than individuals from the general population. Survivor-specific interventions are needed to reduce dental care barriers.

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“…There is no direct measure of eligibility for Medicaid or Marketplace premium subsidies in the NHIS or any other dataset, so it was necessary to generate an algorithm to assess likely eligibility, similar to prior studies evaluating insurance expansions. 7,28,29 As the algorithm used self-reported information on income and family structure, there may be errors in the eligibility assignments, biasing some of the estimated associations toward the null. Second, our sample size for adults with a cancer history may have limited statistical power when assessing coverage changes by eligibility category.…”

Section: Discussionmentioning

confidence: 99%

“…Before the enactment of the Affordable Care Act (ACA), an estimated 14.7% of cancer survivors aged below 65 years (1.4 million) lacked insurance. 7 This situation is largely due to loss of employment-based insurance and/or because of unavailable or unaffordable health insurance in the individual market due to history of cancer. 8,9 Most state Medicaid programs provided coverage only for adults with dependent children, low-income seniors, pregnant women, and the disabled, 10 and because most cancer survivors are not of child bearing age 11 relatively few qualified on this basis.…”

mentioning

confidence: 99%

“…10 Among uninsured cancer survivors aged below 65 years, an estimated 31% would be eligible for tax credits to purchase insurance in the Marketplaces and another 30% would become Medicaid-eligible under the ACA. 7 The ACA included an individual coverage mandate with tax penalties, which was expected to increase coverage across eligibility categories. Evidence from the first 2 years of the program indicates that the ACA was associated with reduced uninsured rates among adults not eligible for Medicare, with estimates ranging from 7.8 to 14.9 percentage points.…”

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confidence: 99%

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Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History

Davidoff¹,

Guy

Hu³

et al. 2018

Medical Care

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Background: The Affordable Care Act (ACA) improved health care coverage accessibility by expanding Medicaid eligibility, creating insurance Marketplaces, and subsidizing premiums. We examine coverage changes associated with ACA implementation, comparing adults with and without a cancer history. Methods: We included nonelderly adults from the 2012 to 2015 National Health Interview Survey. Using information on state Medicaid policies (2013), expansion decisions (2015), family structure, income, insurance offers, and current coverage, we assigned adults in all 4 years to mutually exclusive eligibility categories including: Medicaid-eligible pre-ACA; expansion eligible for Medicaid; and Marketplace premium subsidy eligible. Linear probability regressions estimated pre-post (2012–2013 vs. 2014–2015) coverage changes by eligibility category, stratified by cancer history. Results: The uninsured rate for cancer survivors decreased from 12.4% to 7.7% (P < 0.001) pre-post ACA implementation. Relative to income > 400% of the federal poverty guideline, the uninsured rate for cancer survivors decreased by an adjusted 8.4 percentage points [95% confidence interval (CI), 1.3–15.6] among pre-ACA Medicaid eligible; 16.7 percentage points (95% CI, 9.0–24.5) among expansion eligible, and 11.3 percentage points (95% CI, −0.8 to 23.5, with a trend P = 0.069) for premium subsidy eligible. Decreases in uninsured among expansion-eligible adults without a cancer history [9.7 percentage points (95% CI, 7.4–12.0), were smaller than for cancer survivors (with a trend, P = 0.086)]. Despite coverage gains, ~528,000 cancer survivors and 19.1 million without a cancer history remained uninsured post-ACA, yet over half were eligible for Medicaid or subsidized Marketplace coverage. Conclusions: ACA implementation was associated with large coverage gains in targeted expansion groups, including cancer survivors, but additional progress is needed.

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The Affordable Care Act and Expanded Insurance Eligibility Among Nonelderly Adult Cancer Survivors

Cited by 43 publications

References 25 publications

Health care experiences of long-term survivors of adolescent and young adult cancer

Health care experiences of long-term survivors of adolescent and young adult cancer

Dental Care for Survivors of Adolescent and Young Adult Cancer: Special Considerations

Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History

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