Impact of the affordable care act dependent coverage provision on young adult cancer patient insurance coverage by sociodemographic and economic characteristics
To evaluate the impact of the Affordable Care Act Dependent Care Provision by sociodemographic and economic characteristics in young adult cancer patients.
The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) 18 database were queried for young adult cancer cases diagnosed during 2007–2014. Using a difference-in-differences approach, we examined insurance coverage in different subgroups of policy-eligible 19–25 year-olds versus policy-ineligible 27–29 year-olds from the pre- (2007–2009) to post- (2011–2014) Dependent Care Provision period.
Across subgroups and study populations, insurance coverage increased significantly following the Provision enactment in the policy-eligible versus policy-ineligible group across most subgroups (range in NCDB: 1.83 to 6.38% for low and mid-low education areas, respectively; range in SEER: 1.43 to 6.18 for Non-Hispanic Others and Hispanics, respectively). Heterogenous impacts were observed by sex with a larger impact in males (NCDB: 5.14%, 95% CI 3.59–6.69; SEER: 4.46, 2.12–6.8) than females (NCDB: 2.51%, 95% CI 1.39–3.62; SEER: 2.50, 0.82–4.18). We observed no other statistical evidence for Dependent Care Provision subgroup heterogeneity except for a smaller impact in individuals from low education areas in NCDB.
Our results indicate a positive Dependent Care Provision impact on insurance coverage in young adults with cancer across subgroups, with evidence for a smaller impact in females relative to males and in low relative to high education areas.
KeywordsAffordable care act Dependent coverage Cancer Young adult
Per the NCDB data use agreement, we acknowledge that The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data.
This work was supported by the Center for Health Economics and Policy Pilot Funding Program at the Institute for Public Health at Washington University (PI: Kimberly Johnson, MPH, PhD) and the Siteman Cancer Institute Leah Menshouse Summer Fellowship (Justin Barnes, MS).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.United States Cancer Statistics: 1999–2014 Incidence, WONDER Online Database. United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2016. https://wonder.cdc.gov/cancer-v2014.HTML. Accessed 24 Aug 2018
- 2.United States Cancer Statistics: 1999–2014 Mortality, WONDER Online Database. United States Department of Health and Human Services, Centers for Disease Control and Prevention; 2016. https://wonder.cdc.gov/controller/datarequest/D137. Accessed 24 Aug 2018
- 17.American College of Surgeons (2017) National Cancer Data base, 2004–2015 Participant Use Data Files.Google Scholar
- 18.Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence—SEER 9 Regs Research Data, Nov 2017 Sub (1975–2015) %3cKatrina/Rita Population Adjustment%3e - Linked To County Attributes—Total U.S., 1969–2015
- 21.Insurance Recode Variable—SEER Documentation. https://seer.cancer.gov/seerstat/variables/seer/insurance-recode/. Accessed 20 Dec 2018
- 25.Rural-Urban Continuum Code—SEER Datasets. https://seer.cancer.gov/seerstat/variables/countyattribs/ruralurban.html#definitions.2003. Accessed 29 Oct 2018
- 31.Rubin DB (1987) Multiple imputation for nonresponse in surveys. Wiley, HobokenGoogle Scholar
- 32.Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence - SEER 18 Regs Research Data, Nov 2018 Sub (1973–2016) %3cKatrina/Rita Population Adjustment%3e - Linked To County Attributes—Total U.S., 1969–201
- 37.Scott JW, Salim A, Sommers BD et al (2015) Racial and regional disparities in the effect of the affordable care act’s dependent coverage provision on young adult trauma patients. J Am Coll Surg 221:495–501. https://doi.org/10.1016/j.jamcollsurg.2015.03.032 (e1)CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Longford NT (1993) Random coefficient models. Clarendon Press, LondonGoogle Scholar