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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 220-227 |
| Number of pages | 8 |
| Journal | Medical care |
| Volume | 56 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2018 |
Bibliographical note
Funding Information:A.J.D. has a family member who receives research funding from Celgene. A.J.D. receives research funding from the Commonwealth Fund and PhRMA Foundation. The remaining authors declare no conflict of in-terest.
Funding Information:
Supported by institutional support from Yale Cancer Center, and intramural support from the American Cancer Society, and the Centers for Disease Control and Prevention and National Cancer Institute. No external funding was provided for this research.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
Keywords
- cancer survivors
- eligibility
- health care reform
- insurance
- medicaid
