Abstract
Purpose
To assess changes in health insurance coverage for young cancer patients pre- and post- the Affordable Care Act-Dependent Care Expansion (ACA-DCE) implementation in California. Further, we examined differences in insurance coverage by socioeconomic and race/ethnicity.
Methods
Data were obtained from the California Cancer Registry and Medicaid enrollment files, from 2005 to 2014. We conducted difference-in-difference analyses among 7042 cancer patients aged 22–25 years (“intervention group”) and 25,269 aged 26–34 years (“control group”). We also examined the independent and combined effects of race/ethnicity and neighborhood socioeconomic status (nSES) on insurance coverage.
Results
After the ACA-DCE implementation, we observed a 52.7% reduction in the proportion of uninsured and a 35.7% increase in the proportion of privately insured patients. There was also a 17.3% reduction in Medicaid at cancer diagnosis and a 27.5% reduction in discontinuous Medicaid enrollment. However, these benefits were limited to patients of non-Hispanic White, Hispanic and Asian/Pacific Islander race/ethnicity living in higher nSES, with no differences in insurance enrollment among young adults who lived in low nSES or those of Black race/ethnicity.
Conclusion
The ACA-DCE broadened insurance coverage for young adults with cancer in California. Yet, only certain subgroups of patients have benefited from this policy.
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Funding
This work was supported by the Cancer Research Coordinating Committee (grant number CRR-17-420784). The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. RA’s work was funded by the National Research Service Award (NRSA) for Primary Medical Care, from the Health Resources and Services Administration (HRSA), award T32HP300370401. HMP is supported in part by NIH P30 CA77598 (Masonic Cancer Center). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Study concept and design: Maguire, Keegan. Acquisition, analysis, or interpretation of data: Maguire, Keegan, Abrahão, Parsons. Drafting of the manuscript: Abrahão. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Maguire. Study supervision: Maguire, Keegan.
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Abrahão, R., Maguire, F.B., Morris, C.R. et al. The influence of the Affordable Care Act-Dependent Care Expansion on insurance coverage among young cancer survivors in California: an updated analysis. Cancer Causes Control 32, 95–101 (2021). https://doi.org/10.1007/s10552-020-01360-7
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DOI: https://doi.org/10.1007/s10552-020-01360-7