Elysia M Alvarez1, Theresa H Keegan2, Emily E Johnston1, Robert Haile3, Lee Sanders4, Paul H Wise5, Olga Saynina5, Lisa J Chamberlain4. 1. Division of Pediatric Hematology and Oncology, Stanford University School of Medicine, Palo Alto, California. 2. Division of Hematology and Oncology, University of California at Davis School of Medicine, Sacramento, California. 3. Division of Oncology, Stanford University School of Medicine, Palo Alto, California. 4. Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, California. 5. The Center for Policy, Outcomes and Prevention, Stanford University, Palo Alto, California.
Abstract
BACKGROUND: Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. METHODS: The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level. RESULTS: Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods. CONCLUSIONS: The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7.
BACKGROUND: Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. METHODS: The current study was a retrospective, population-based analysis of hospitalized young adult oncology patients (aged 22-30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and federal poverty level. RESULTS: Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA-DCE, compared with white patients. Younger age (22-25 years) was associated with having private insurance after implementation of the ACA-DCE (odds ratio, 1.20; 95% confidence interval, 1.06-1.35). In the difference-in-difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium-income (2006-2009: 64.6% vs 2011-2014: 69.1%; P = .003) and high-income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high-income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods. CONCLUSIONS: The ACA-DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110-7.
Authors: Elysia M Alvarez; Marcio Malogolowkin; Jeffrey S Hoch; Qian Li; Ann Brunson; Brad H Pollock; Lori Muffly; Ted Wun; Theresa H M Keegan Journal: JCO Oncol Pract Date: 2020-06-11
Authors: Giselle K Perez; John M Salsman; Kaitlyn Fladeboe; Anne C Kirchhoff; Elyse R Park; Abby R Rosenberg Journal: Am Soc Clin Oncol Educ Book Date: 2020-03
Authors: Theresa H M Keegan; Helen M Parsons; Yi Chen; Frances B Maguire; Cyllene R Morris; Arti Parikh-Patel; Kenneth W Kizer; Ted Wun Journal: J Natl Cancer Inst Date: 2019-11-01 Impact factor: 13.506
Authors: Viswatej Avutu; Varun Monga; Nupur Mittal; Aniket Saha; Jeffrey R Andolina; Danielle E Bell; Douglas B Fair; Jamie E Flerlage; Jamie N Frediani; Jessica L Heath; Justine M Kahn; Jennifer L Reichek; Leanne Super; Michael A Terao; David R Freyer; Michael E Roth Journal: JCO Oncol Pract Date: 2021-12-14
Authors: Lori Wiener; Sima Bedoya; Haven Battles; Leonard Sender; Keri Zabokrtsky; Kristine A Donovan; Lora M A Thompson; Barbara B Lubrano di Ciccone; Margarita Bobonis Babilonia; Karen Fasciano; Paige Malinowski; Maureen Lyon; Jessica Thompkins; Corey Heath; Denise Velazquez; Karen Long-Traynor; Abigail Fry; Maryland Pao Journal: Palliat Support Care Date: 2022-08
Authors: Heydon K Kaddas; Samantha T Pannier; Karely Mann; Austin R Waters; Sara Salmon; Tomoko Tsukamoto; Echo L Warner; Brynn Fowler; Mark A Lewis; Douglas B Fair; Anne C Kirchhoff Journal: J Adolesc Young Adult Oncol Date: 2019-09-16 Impact factor: 2.223