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Impact of the affordable care act dependent coverage provision on young adult cancer patient insurance coverage by sociodemographic and economic characteristics

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Abstract

Purpose

To evaluate the impact of the Affordable Care Act Dependent Care Provision by sociodemographic and economic characteristics in young adult cancer patients.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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.

Funding

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).

Author information

Authors and Affiliations

  1. Saint Louis University School of Medicine, St. Louis, MO, USA

    Justin M. Barnes

  2. Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA

    Justin M. Barnes, Derek S. Brown, Allison A. King & Kimberly J. Johnson

  3. Brown School, Washington University in St. Louis, St. Louis, MO, USA

    Derek S. Brown, Jenine K. Harris & Kimberly J. Johnson

  4. Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA

    Allison A. King

  5. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Allison A. King

  6. Department of Pediatrics, Division of Hematology/Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO, USA

    Allison A. King

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  1. Justin M. Barnes
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Correspondence to Kimberly J. Johnson.

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Barnes, J.M., Brown, D.S., Harris, J.K. et al. Impact of the affordable care act dependent coverage provision on young adult cancer patient insurance coverage by sociodemographic and economic characteristics. Cancer Causes Control 31, 33–42 (2020). https://doi.org/10.1007/s10552-019-01246-3

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  • DOI: https://doi.org/10.1007/s10552-019-01246-3

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