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 “Either the impact of the ACA was that people who were now insured
had access to screening services that uncovered cancer, or people
who knew they had cancer came forward. Their journey was at least
less stressful because they were covered and had access to care,”
Dr. Clifford A. Hudis, chief executive officer of the American
Society of Clinical Oncology, told Reuters Health by phone.
“My only wish is that the evidence in this study would have some
positive impact and influence the current debate about the potential
rollback of a provision that might have given us some gains,” said
Hudis, who wasn’t involved in the study.
Starting in January 2014, the ACA - commonly called Obamacare -
expanded Medicaid coverage and provided subsidies so nonelderly
Americans could buy affordable health insurance. It led to historic
gains in the number of people covered by health insurance.
For the analysis, published online October 19 in JAMA Oncology,
researchers used the National Cancer Institute’s Surveillance,
Epidemiology, and End Results (SEER) database to analyze the
percentages of uninsured patients with newly diagnosed cancers from
2010 to 2014.
Overall, they looked at data on more than 858,000 adults, ages 19 to
64, in 13 states. The states include 28% of the population and are
representative of national demographics, said lead author Aparna
Soni, a doctoral candidate in business economics and public policy
at Indiana University in Bloomington.
Nine states in the study participated in the ACA’s Medicaid
expansion program; the other four did not.
In 2014, after ACA was implemented, the uninsured rate remained
unchanged in states in the SEER database without Medicaid expansion
but “declined sharply” in expansion states, Soni’s team reports.
Overall, the proportion of new cancer patients who were uninsured
fell to 3.8% from 5.7% in the preceding three years – a decrease of
about 16,500 people, or 33%.
Lack of insurance has been linked with late cancer diagnosis, poorer
treatment and poor survival, said Ahmedin Jemal, vice president for
surveillance and health services research at the American Cancer
Society.
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“We can’t underestimate the importance of the Medicaid program which
provides timely access to cancer care,” Jemal said.
The study found significant gains in insurance coverage across many
ethnic and demographic groups, as well as numerous stages and types
of common cancers, including colorectal, prostate, thyroid, breast
and lung and bronchial cancers.
The proportion of newly diagnosed cancer patients without insurance
dropped by 39.9% among adults of Hispanic ethnicity and by 46.2%
among “other” ethnicities.
By cancer type, the largest decrease in percent uninsured – a drop
of 32.7% - occurred in patients with lung and bronchial cancer.
There was a 33.3% decline in uninsured patients with cancer that had
spread to other places in the body.
Soni pointed out in a phone interview that although the research
didn’t examine the effect of insurance coverage on cancer diagnosis,
people without insurance coverage are more likely to wait and see
their physician only when they can’t ignore their symptoms so they
are more likely to be diagnosed with late-stage cancer.
“Cancer treatment is very expensive. Without insurance it is
unaffordable. Insurance status determines the type of treatment
someone can afford,” Soni said.
The study only included data from 13 states and tracked insurance
coverage for only one year after the ACA was implemented.
Soni said there could be further decreases in uninsured adults with
new cancer diagnoses during the remaining years of the program.
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