ACA Decreased Proportion of Uninsured Patients With Newly Diagnosed Cancer

A substantially higher number of nonelderly patients with newly diagnosed cancer had insurance after implementation of the Affordable Care Act (ACA), according to the results of a new study. This decline in the percentage of uninsured patients was particularly high in patients who resided in states with Medicaid expansion. These results were published in the Journal of Clinical Oncology.

“We also found a small, albeit statistically significant, shift toward diagnosis of stage I disease for some common cancers,” wrote Ahmedin Jemal, DVM, PhD, of the Surveillance and Health Services Research program at the American Cancer Society, and colleagues. “The findings could inform ongoing healthcare reform and reinforces the continued need for additional expansion of access to care, especially for low-income populations.”

According to the study, having insurance coverage is critical for patients with newly diagnosed cancer because it could influence initial treatment trajectories.

“Lack of insurance has been associated with late-stage diagnosis, receipt of suboptimal care, and poor survival after a diagnosis of cancer,” the researchers explained.

Jemal and colleagues used the National Cancer Data Base to examine changes in stage at diagnosis for the top 15 solid cancers in both men and women from 2011 to the third quarter of 2013 (pre-ACA implementation) to 2014 (post-ACA). They calculated the absolute change and relative changes in insurance.

From pre-ACA to post-ACA, the percentage of uninsured patients with newly diagnosed cancer decreased in all income categories in both Medicaid expansion and nonexpansion states. The decrease in uninsured patients was highest in low-income patients in expansion states (from 9.6% to 3.6%; −6.0%) compared with patients in nonexpansion states (14.7% to 13.3%; −1.4%).

“These findings reinforce the need for the expansion of Medicaid or the formation of a comparable program to ensure access to care for all low-income people regardless of their residence rather than a rollback of state Medicaid expansion,” the researchers wrote.

Data showed a small but significant shift toward the diagnosis of stage I disease for colorectal, lung, female breast, and pancreatic cancers, as well as melanoma, in Medicaid expansion states, and for female breast and lung cancers in nonexpansion states. However, these differences were not significant in the adjusted differences analysis. In contrast, the proportion of stage I prostate cancer diagnosed in both expansion and nonexpansion states decreased.

“Reasons for the small shift toward early-stage diagnosis for select common cancers, including colon and lung, are unknown but may reflect improved access to screening services and assessment of early symptoms,” the researchers wrote. “In contrast, the shift to late-stage diagnosis for prostate cancer may reflect the discontinuation of routine prostate-specific antigen testing.”