The Impact of the Affordable Care Act on Cancer Survivorship

Leopold, Christine; Park, Elyse R.; Nekhlyudov, Larissa

doi:10.1097/ppo.0000000000000263

Cited by 17 publications

(14 citation statements)

References 80 publications

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“…Before the implementation of the ACA, many CCS lost their health insurance as they entered adulthood, eliminating a financial connection to the health care system. 32,33 The expansion of coverage under the ACA closed that gap for many by providing more public and private options for CCS as young adults. 31 Expanded coverage was particularly helpful for CCS who could now more easily obtain or retain insurance during the critical transitional period from pediatric to adult care.…”

Section: Conclusion and Policy Implicationsmentioning

confidence: 99%

Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors

Cousineau

Kim

Hamilton

et al. 2019

INQUIRY

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The objective of this study was to assess the role of health insurance coverage on patterns of health care utilization and access to cancer-related follow-up and non-cancer care among childhood cancer survivors (CCS). Cross-sectional survey design was used. Childhood cancer survivors were from 2 large hospitals in Los Angeles County. In all, 235 were identified through the Los Angeles Cancer Surveillance Program, diagnosed between the ages of 5 and 18 in 2000-2007 with any cancer type except Hodgkin lymphoma. At data collection in 2009-2010, participants were between 15 and 25 years old. Study exposure was health insurance coverage (private, public, and uninsured). Main outcomes and measures were respondents’ regular source of care for cancer follow-up, noncancer care, and both; and having a cancer follow-up visit, primary care visit, and hospital emergency department visit in the past 2 years. Compared with those with private insurance, the uninsured were less likely to have a regular source for cancer follow-up (odds ratio [OR] = 4.3, 95% confidence interval [CI] = 1.9-9.4), less likely to have a source for noncancer care (OR = 3.3, 95% CI 1.6-6.9), and less likely to have a source of care for both (OR = 5.3, 95% CI = 2.1-13.5). Furthermore, uninsured CCS were less likely to have made visits to cancer specialists (OR = 4.5, 95% CI = 2.1-9.50) and were less likely to have seen a primary care physician in the past 2 years (OR = 3.9, 95% CI = 1.8-8.2). In addition, those with public (vs private) insurance were less likely to have a regular provider for primary care (OR = 2.5, 95% CI = 1.1-5.4) and less likely to have made a primary care visit in the past year (OR = 2.8, 95% CI = 2.1-13.5). Uninsured CCS are at risk of not obtaining cancer follow-up care, and those with public (vs. private) insurance have less access to primary care. Policies that ensure continuity of coverage for survivors as they age into adulthood may result in fewer barriers to needed care, which may lead to fewer health problems for CCS in the future.

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Section: Conclusion and Policy Implicationsmentioning

confidence: 99%

Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors

Cousineau

Kim

Hamilton

et al. 2019

INQUIRY

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“…Signed into law on March 23, 2010, the Patient Protection and Affordable Care Act (ACA) is the largest health care system change in the United States since the establishment of the Medicare and Medicaid programs in 1965. Its goals are to improve health insurance coverage, the quality of care, and patient outcomes, and to maintain or lower costs by catalyzing change in the health care delivery system 12‐14 . The implementation of the ACA can have far‐reaching effects throughout the cancer control continuum, including prevention and screening, diagnosis, treatment, survivorship, and end‐of‐life care (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Several earlier reviews have synthesized the research findings of the effects of the ACA on various aspects of cancer care, 12,15‐20 although prior reviews were mainly based on studies published before 2017 and only focused on a single provision or a part of the cancer control continuum. With data maturation and the increasing number of well designed studies published since 2017, a comprehensive and updated synthesis of research addressing the ACA in cancer care is needed.…”

Section: Introductionmentioning

confidence: 99%

The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years

Zhao

Mao

Fedewa

et al. 2020

CA A Cancer J Clinicians

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Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care than their counterparts with health insurance coverage. On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law, representing the largest change to health care delivery in the United States since the introduction of the Medicare and Medicaid programs in 1965. The primary goals of the ACA are to improve health insurance coverage, the quality of care, and patient outcomes, and to maintain or lower costs by catalyzing changes in the health care delivery system. In this review, we describe the main components of the ACA, including health insurance expansions, coverage reforms, and delivery system reforms, provisions within these components, and their relevance to cancer screening and early detection, care, and outcomes. We then highlight selected, well-designed studies examining the effects of the ACA provisions on coverage, access to cancer care, and disparities throughout the cancer control continuum. Finally, we identify research gaps to inform evaluation of current and emerging health policies related to cancer outcomes. CA Cancer J Clin 2020;70:165-181.

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“…This study suggests that the ACA improves access to screening, preventative services, and treatment, but does not draw conclusions about improved survivorship and notes gaps in the literature. 12 Larger studies evaluating ACA-or Medicaid expansion-related survival have not been performed.…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act

Kirkpatrick

Dunn

Tuttle

2020

The American Surgeon

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Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion ( P = 0.56). Statewide data similarly demonstrated no change ( P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients’ decision to seek breast cancer screening and care.

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The Impact of the Affordable Care Act on Cancer Survivorship

Cited by 17 publications

References 80 publications

Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors

Insurance Coverage, and Having a Regular Provider, and Utilization of Cancer Follow-up and Noncancer Health Care Among Childhood Cancer Survivors

The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years

Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act

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