Impact of health care reform legislation on uninsured and medicaid-insured cancer patients.

The Patient Protection and Affordable Care Act of 2010 is the most important US health legislation since the creation of Medicare and Medicaid in 1965. Repeated attempts at a complete overhaul of the health care system under various administrations and 4 decades of incrementalism in our approach to health policy making paved the way for this historic legislation. Major components of the recently enacted legislation include a substantial expansion of the Medicaid program to include 17.1 million currently uninsured adults with incomes below 133% of the federal poverty line, a mandated minimum health benefits package, a renewed focus on prevention, the establishment of state health exchanges with special provisions to permit affordability by those with incomes below 400% of the federal poverty line, and the establishment of high-risk health insurance pools for patients who were previously denied coverage because of preexisting conditions. The time for change was long overdue. Although many challenges exist, particularly for the states, in the implementation phase of the Affordable Care Act, the benefit to low-income cancer patients is increased access to guideline-recommended levels of screening, diagnostic, treatment, and follow-up services.