With ACA, Uninsured New Cancer Patients Hit Historic Low

Kristin Jenkins

October 20, 2017

The number of adults in the United States facing a first-time cancer diagnosis with no health insurance fell by one third in 2014, the first full year that the Affordable Care Act (ACA), or "Obamacare," was in effect, say researchers.

Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program show that in 2013, 5.73% of new cancer patients were uninsured at the time of diagnosis compared with 3.81% adults in 2014, according to Aparna Soni, MA, from the Kelley School of Business at Indiana University, Bloomington, and colleagues.

The 1.92–percentage point absolute decrease (P < .001) or 33.51% relative drop in the number of uninsured individuals with a new cancer diagnosis who were aged 19 to 64 years represents an "historic low," they report in a research letter published online October 19 in JAMA Oncology.

A secondary analysis reveals that in 2014, nine states that underwent Medicaid expansion experienced even larger decreases in the number of uninsured adults with newly diagnosed cancer, with rates dropping an additional 2.38 percentage points. These states are California, Connecticut, Hawaii, Iowa, Kentucky, Michigan, New Mexico, New Jersey, and Washington. Not all US states underwent Medicaid expansion.

"Future research should examine effects of coverage on cancer diagnoses, treatment and outcomes," the researchers write. "Policy changes that reduce Medicaid funding or weaken protections for individuals with preexisting conditions could be particularly harmful for patients with cancer."

For the analysis, which used SEER data for 858,193 adults with new cancer diagnoses, the researchers compared the percentage of patients with newly diagnosed cancer who were uninsured in 2014 —  the year that Obamacare kicked into gear and Medicaid was expanded in a handful of states —  with 2010-2013 rates of noninsurance.

Significant gains in insurance coverage were seen across common types of nonskin cancer, including breast, prostate, colorectal, and thyroid cancer. However, the largest absolute and relative declines in noninsurance rates were seen in lung and bronchial cancer, and for distant disease followed by local disease.

Large increases in insurance coverage were also seen across multiple demographic groups, particularly those of Hispanic ethnicity. This finding, which is in keeping with results from other studies of changes in insurance coverage, access to care, and health, may indicate that disparities in healthcare coverage are narrowing, the researchers suggest.

Without healthcare insurance, treatment is often unaffordable and can result in a delayed cancer diagnosis, they add, pointing to recent evidence suggesting that expanding insurance coverage could improve cancer-related outcomes.

Increasing early cancer detection was a stated objective of the ACA, and this study quantifies how effective it was in increasing insurance coverage among patients with  cancer, Soni told Medscape Medical News. "In future projects, we plan to assess the downstream effects of this increased insurance coverage on diagnosis, treatment, and mortality," she said, noting that this work is already underway.

Clinicians in non-Medicaid expansion states are more likely to be working with uninsured patients, for whom cancer treatment could be unaffordable, she also suggested. Another effect of the ACA is that healthcare providers in Medicaid expansion states could be faced with newly insured patients who don't have a lot of experience interacting with the healthcare system.

Limitations of the analysis include the fact that use of data from only 13 states and from 1 year post-ACA.

This analysis was funded by the National Cancer Institute, the Office of Behavioral and Social Sciences Research, and the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

JAMA Oncol. Published online October 19, 2017. Abstract

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