Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act
Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act
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DOI：
10.1200/jop.2017.027102
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发表时间：
2018-02-01
影响因子：
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通讯作者：
Chino, Junzo
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文献类型：
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作者：
Moss, Haley A.;Havrilesky, Laura J.;Chino, Junzo
目的平价医疗法案 (ACA) 旨在通过扩大医疗补助资格和执行个人授权等关键条款来增加保险覆盖范围。本研究的目的是探讨 ACA 对新诊断结肠癌、肺癌或乳腺癌患者保险费率的影响。方法使用 SEER 数据库，确定了 2008 年至 2014 年间诊断出结肠癌、肺癌或乳腺癌的 65 岁以下患者。在《平价医疗法案》通过之前与之后（2011 年）以及医疗补助扩张之前（2011 年至 2013 年）与之后（2014 年）在 9 个扩张州和 5 个非扩张州对保险费率进行了检查。使用双重差分模型来评估 ACA 在扩展州与非扩展州之间的不同影响。结果 2008 年至 2014 年间，共有 414,085 名已知保险状况的患者被诊断患有结肠癌、肺癌或乳腺癌。对于所有癌症类型，2011 年之后在扩展州加入医疗补助的患者人数显着增加。 2011年至2013年和2014年期间，在医疗补助扩大的州的患者中，新诊断出肺癌和结肠癌的患者的未投保率下降了> 50%（分别为2011年至2013年的6.5%至2014年的3.1%和2011至2013年的6.8%至2014年的3.4%；P < 001）；乳腺癌患者的未投保率下降幅度较小（2011 年至 2013 年为 2.7%，2014 年为 1.6%；P < .001）。生活在非扩张状态的患者中，没有保险的患者比例没有下降。结论 ACA 扩大了诊断为结肠癌、肺癌和乳腺癌的患者的保险覆盖范围。然而，只有在增加医疗补助资格的州才能观察到这种影响。
PurposeThe Affordable Care Act (ACA) aimed to increase insurance coverage through key provisions such as expansion of Medicaid eligibility and enforcement of an individual mandate. The objective of this study is to examine the impact of the ACA on insurance rates among patients newly diagnosed with colon, lung, or breast cancer.MethodsUsing the SEER database, patients younger than age 65 years diagnosed with colon, lung, or breast cancer between 2008 and 2014 were identified. Insurance rates were examined before versus after passage of the ACA (2011) and before (2011 to 2013) versus after (2014) Medicaid expansion in nine expansion states and five nonexpansion states. Difference-in-differences models were used to estimate the differential impact of ACA in expansion compared with nonexpansion states.Results A total of 414,085 patients with known insurance status were diagnosed with colon, lung, or breast cancer between 2008 and 2014. For all cancer types, there was a significant increase in patients enrolled in Medicaid after 2011 in expansion states. Between 2011 to 2013 and 2014, in patients living in states with Medicaid expansion, the uninsured rates decreased by > 50% among patients with a new diagnosis of lung and colon cancer (6.5% in 2011 to 2013 to 3.1% in 2014 and 6.8% in 2011 to 2013 to 3.4% in 2014, respectively; P < 001); the uninsured rate decreased to a lesser degree for patients with breast cancer (2.7% in 2011 to 2013 to 1.6% in 2014; P < .001). This decrease in the rate of uninsured patients was absent in patients living in nonexpansion states.ConclusionThe ACA resulted in expanded insurance coverage for patients diagnosed with colon, lung, and breast cancer. However, the impact was only observed in states that increased their Medicaid eligibility.