Amy J Davidoff1,2, Gery P Guy3, Xin Hu2, Felisa Gonzales4, Xuesong Han5, Zhiyuan Zheng5, Helen Parsons6, Donatus U Ekwueme3, Ahmedin Jemal5. 1. Department of Health Policy and Management, Yale School of Public Health. 2. Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, CT. 3. Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. 4. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD. 5. Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA. 6. Research Data Assistance Center (ResDAC), University of Minnesota, Minneapolis, MN.
Abstract
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.
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.
Authors: Anthony S Robbins; Xuesong Han; Elizabeth M Ward; Edgar P Simard; Zhiyuan Zheng; Ahmedin Jemal Journal: JAMA Date: 2015-11-24 Impact factor: 56.272
Authors: Lisa M Pollack; Donatus U Ekwueme; Mei-Chuan Hung; Jacqueline W Miller; Su-Hsin Chang Journal: Cancer Causes Control Date: 2020-05-20 Impact factor: 2.506
Authors: K Robin Yabroff; Katherine Reeder-Hayes; Jingxuan Zhao; Michael T Halpern; Ana Maria Lopez; Leon Bernal-Mizrachi; Anderson B Collier; Joan Neuner; Jonathan Phillips; William Blackstock; Manali Patel Journal: J Natl Cancer Inst Date: 2020-07-01 Impact factor: 13.506
Authors: Xuesong Han; Jingxuan Zhao; Zhiyuan Zheng; Janet S de Moor; Katherine S Virgo; K Robin Yabroff Journal: Cancer Epidemiol Biomarkers Prev Date: 2020-01-15 Impact factor: 4.254
Authors: Avirup Guha; Amit Kumar Dey; Sadeer Al-Kindi; P Elliott Miller; Arjun K Ghosh; Amitava Banerjee; Juan Lopez-Mattei; Nihar R Desai; Brijesh Patel; Guilherme H Oliveira; Marcos de Lima; Michael Fradley; Daniel Addison Journal: Am J Cardiol Date: 2020-11-18 Impact factor: 2.778