scholarly journals Association of Medicaid Expansion Under the Affordable Care Act with Insurance Status and Clinical Characteristics of Low-Income Patients with Newly Diagnosed Melanoma

2020 ◽  
Author(s):  
Pranav Puri ◽  
Mark R. Pittelkow ◽  
Lanyu Mi ◽  
Aaron R. Mangold
Keyword(s):  
Overall Survival ◽  
Affordable Care Act ◽  
Low Income ◽  
Clinical Characteristics ◽  
Insurance Status ◽  
Medicaid Expansion ◽  
Newly Diagnosed ◽  
Uninsured Patients ◽  
Time Period ◽  
Expansion Time

Importance: The Affordable Care Act expanded Medicaid eligibility in participating states to individuals with incomes up to 138% of the federal poverty line. The effects of this policy on the diagnosis and treatment of melanoma in low-income populations has yet to be described. Objective: To evaluate the effect of Medicaid expansion on changes in insurance status and clinical characteristics of low-income patients with newly diagnosed melanoma. Design, Setting, and Participants: This cross-sectional study included patients younger than 65 with a new diagnosis of malignant melanoma from January 1, 2011 to December 31, 2016, in the US National Cancer Institute's Surveillance Epidemiology and End Results database. Exposures: Residence in a state that expanded Medicaid on January 1, 2014. Main Outcomes and Measures: The primary outcomes were insurance status, melanoma staging, and overall survival. Results: In Medicaid expansion states, there were 1,719 low-income patients with newly diagnosed melanoma during the pre-expansion time period and 1,984 (15% increase) during the post-expansion time period. In nonexpansion states, there were 326 low-income patients with newly diagnosed melanoma during the pre-expansion time period, and 288 during the post-expansion time period (12% decrease). Compared with nonexpansion states, expansion states had a significantly greater reduction in percentage of uninsured patients following Medicaid expansion (adjusted odds ratio, 6.27 [95% CI, 4.83 to 8.14]). Overall survival was not statistically different between expansion and nonexpansion states (HR, 0.89 [95% CI, 0.74 to 1.06]). There were no statistically significant differences in melanoma staging at diagnosis between the expansion and nonexpansion groups (p=0.05). Conclusions and Relevance: Medicaid expansion was associated with increased melanoma diagnoses in low-income patients and a decreased proportion of uninsured patients. However, our study did not identify differences in clinical outcomes associated with Medicaid expansion.

Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients With Cancer After the Affordable Care Act

2017 ◽  
Vol 35 (35) ◽  
pp. 3906-3915 ◽  
Author(s):  
Ahmedin Jemal ◽  
Chun Chieh Lin ◽  
Amy J. Davidoff ◽  
Xuesong Han
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Early Stage ◽  
Significant Shift ◽  
Cancer Type ◽  
Medicaid Expansion ◽  
Newly Diagnosed ◽  
Difference In Differences ◽  
Cancer Data ◽  
The Affordable Care Act

Purpose To examine change in the percent uninsured and early-stage diagnosis among nonelderly patients with newly diagnosed cancer after the Affordable Care Act (ACA). Patients and Methods By using the National Cancer Data Base, we estimated absolute change (APC) and relative change in percent uninsured among patients with newly diagnosed cancer age 18 to 64 years between 2011 to the third quarter of 2013 (pre-ACA implementation) and the second to fourth quarter of 2014 (post-ACA) in Medicaid expansion and nonexpansion states by family income level. We also examined demographics-adjusted difference in differences in APC between Medicaid expansion and nonexpansion states. We similarly examined changes in insurance and early-stage diagnosis for the 15 leading cancers in men and women (top 17 cancers total). Results Between the pre-ACA and post-ACA periods, percent uninsured among patients with newly diagnosed cancer decreased in all income categories in both Medicaid expansion and nonexpansion states. However, the decrease was largest in low-income patients who resided in expansion states (9.6% to 3.6%; APC, −6.0%; 95% CI, −6.5% to −5.5%) versus their counterparts who resided in nonexpansion states (14.7% to 13.3%; APC, −1.4%; 95% CI, −2.0% to −0.7%), with an adjusted difference in differences of −3.3 (95% CI, −4.0 to −2.5). By cancer type, the largest decrease in percent uninsured occurred in patients with smoking- or infection-related cancers. A small but statistically significant shift was found toward early-stage diagnosis for colorectal, lung, female breast, and pancreatic cancer and melanoma in patients who resided in expansion states. Conclusion Percent uninsured among nonelderly patients with newly diagnosed cancer declined substantially after the ACA, especially among low-income people who resided in Medicaid expansion states. A trend toward early-stage diagnosis for select cancers in expansion states also was found. These results reinforce the importance of policies directed at providing affordable coverage to low-income, vulnerable populations.

The association between the Affordable Care Act on insurance status, cancer stage, and overall survival in patients with renal cell carcinoma.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 281-281
Author(s):  
Juan Javier-Desloges ◽  
Julia Yuan ◽  
Shady Soliman ◽  
Kevin Hakimi ◽  
Margaret Frances Meagher ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Affordable Care Act ◽  
Low Income ◽  
Cox Regression ◽  
Stage Migration ◽  
Insurance Status ◽  
Cancer Stage ◽  
Medicaid Expansion ◽  
Middle Income ◽  
Income Status

281 Background: We aimed to determine whether insurance expansions implemented through the Patient Protection and Affordable Care Act (ACA) were associated with changes in insurance coverage status, stage at diagnosis, and overall survival for patients with renal cell carcinoma (RCC). Methods: We identified patients 40 to 64 years old diagnosed with RCC between 2010 and 2016 in the National Cancer Database. States were categorized as participating on time in Medicaid expansion or not participating. We stratified patients into advanced cancer (stage III + IV) and localized cancer (stage I + II) groups. We stratified patients into low, middle, and high income groups. Stage trend and insurance trend analysis were performed to based on income status amongst patients living in expansion and non-expansion states. Absolute percentage change (APC) was calculated for insurance status and stage migration. Cox Regression Multivariable Analysis was conducted to assess risk of all-cause mortality (ACM) for patients before and after the implementation of the ACA, adjusting for insurance status, income, education, age, race, ethnicity, comorbidity, and living in an expansion state. Results: We identified 78,099 patients who met inclusion criteria. Following implementation of ACA, APC of patients with insurance increased in both Medicaid and non-expansion states by 4.0% and 2.10% (p<0.01), respectively. The largest increases occurred in expansion states, with low income patients acquiring Medicaid (APC +11.0% p<0.01), middle income patients acquiring Medicaid (APC +8.20% p<0.01), and high-income patients acquiring Medicaid (APC +4.0% p<0.01). In our stage trend analysis, there was a higher proportion of patients with localized stage disease after the implementation of the ACA in low income (APC +4.0% p<0.01) and middle-income patients (APC +1.6% p=0.02.) who live in expansions states, as well as middle income patients in non-expansions states (APC 1.4% p=0.02). Cox Regression MVA revealed that before ACA implementation, low income and middle income were associated with higher risk of mortality (HR 1.29 95%CI 1.18-1.40 p<0.01) and (HR 1.18 95% CI 1.10-1.26, p<0.01, but was not following ACA implementation (p=0.20) and (p=0.05) respectively. Conclusions: Following the implementation of the ACA the proportion of patients with newly diagnosed RCC with health insurance increased with the largest effects seen in Medicaid expansions states. In addition, higher proportions of patients were diagnosed with localized disease in Medicaid expansion states amongst low- and middle-income patients. Furthermore, income status ceased being a risk factor for mortality following ACA implementation. Our findings suggest that ACA implementation has been associated with downward stage migration in low/middle-income patients and attenuation of income status as a risk for mortality in RCC.

Effect of increasing Medicaid coverage in Medicaid expansion states on stage at presentation for urologic malignancies.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 400-400
Author(s):  
Xiaosong Meng ◽  
Hersh Trivedi ◽  
Alexander P. Kenigsberg ◽  
Rashed Ghandour ◽  
Vitaly Margulis ◽  
...  
Keyword(s):  
Low Income ◽  
Poverty Line ◽  
Testis Cancer ◽  
Medicaid Expansion ◽  
Uninsured Patients ◽  
Medicaid Coverage ◽  
Time Period ◽  
Before And After ◽  
Urologic Malignancies

400 Background: Medicaid Expansion (ME) was introduced by the Affordable Care Act to improve access to care for low income individuals by increasing the annual income limits to 138% of the poverty line. However, not all states have elected to participate in ME. Using the National Cancer Database (NCDB), we sought to assess the effects of participation in ME on the four most common urologic malignancies. Methods: The NCDB was queried for bladder, prostate, kidney and testis cancer from 2012-2016, to span the time period two years before and two years after the main ME which took place in 2014. Trends in insurance status at time of diagnosis and effects on stage at presentation before and after ME were analyzed. Results: The percentage of patients with Medicaid coverage at the time of diagnosis for all four urologic malignancies increased significantly after 2014, with a commiserate decrease in the percentage of uninsured patients (Table). By 2016, significantly more patients had Medicaid coverage at diagnosis in ME states compared to those in Non-ME states (bladder 5.0% vs 2.5%, prostate 5.9% vs 2.2%, kidney 9.7% vs 4.1%, 19.5% vs 7.2%, all p < 0.01). However, the stage at presentation for all four urologic malignancies did not significantly differ for patients in ME versus non-ME states. Conclusions: Despite an increase in the proportion of patients with Medicaid coverage after 2014, surprisingly, there was not an associated change in stage at presentation for urologic malignancies in ME states. Further long-term analysis is necessary to evaluate if expanded Medicaid coverage impacts overall survival in this patient population.[Table: see text]

Insurance status and survival in diffuse large B-cell lymphoma: A National Cancer Database study before and after the Affordable Care Act.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6539-6539
Author(s):  
Antoine N Saliba ◽  
Xavier Andrade-Gonzalez ◽  
Paul Joseph Hampel ◽  
Jithma P. Abeykoon ◽  
Allison Bock ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Cell Lymphoma ◽  
Private Insurance ◽  
B Cell Lymphoma ◽  
Insurance Status ◽  
Newly Diagnosed ◽  
Uninsured Patients ◽  
Large B Cell Lymphoma ◽  
Before And After ◽  
Insured Patients

6539 Background: The impact of insurance status on survival in diffuse large B‐cell lymphoma (DLBCL), the most common aggressive lymphoma, has not been evaluated after the implementation of the Affordable Care Act (ACA). The aim of this study is to compare overall survival (OS) in patients across insurance status groups and in the periods before and after the ACA. Methods: Adult patients with newly diagnosed DLBCL were identified from the National Cancer Database. The analysis was restricted to patients 64 years of age or younger as most patients 65 years or older are eligible for Medicare under the ACA. The 2004-2017 period was chosen to represent the immunochemotherapy era preceding and following the ACA. Logistic regression was used to explore associations between abstracted variables and insurance status groups. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis. Results: 93,692 adults (age < 64 years) with newly diagnosed DLBCL and known insurance status were identified (41.3% female, median age 54 years [range: 18 – 64], 81.8% White and 12.1% Black). 7,211 (7.7%) patients were uninsured, 64,744 (69.1%) had private insurance, 11,936 (12.7%) had Medicaid, and 9,801 (10.5%) had Medicare. When compared to insured patients (private insurance, Medicaid or Medicare), uninsured patients were more likely to have a median household outcome of < $38,000 [OR 1.93 (95% CI 1.79-2.07)], less likely to receive chemotherapy [OR 0.69 (0.64-0.77)], more likely to be male [OR 1.14 (1.07-1.21)], more likely to be non-White [OR 1.30 (1.20-1.40], and more likely to present with stage III or IV disease [OR 1.24 (1.16-1.32)]. Uninsured patients had an inferior OS [HR 1.21 (95% CI 1.15-1.27)] when compared to insured patients after adjustment for baseline comorbidity (Charlson-Deyo score ≥2), advanced stage, treatment with chemotherapy, and sociodemographic factors including sex, age, race, household income, facility type (academic/community), and location (urban/rural). With a median follow-up time of 14.8 years (95% CI 14.6-not reached), median OS was lower in uninsured patients [13.4 years (12.3-not reached) vs 14.8 years (14.7-not reached); p < 0.0001]. Despite the lack of major changes in DLBCL therapies, a diagnosis after the implementation of the ACA (in 2010 or later) was associated with a superior OS when compared with the outcomes of patients diagnosed in 2010 or earlier [HR 0.93 (95% CI 0.90-0.95)]. Similarly, five-year OS was superior in the insured group [HR 0.93 (95% CI 0.89-0.96)]. Conclusions: Uninsured patients with DLBCL and < 64 years old had inferior OS when compared with insured patients, and uninsured status emerged as an independent risk factor for inferior OS. Our data highlight the independent effect of insurance disparities - a potential indicator of variations in access to health care - on survival in DLBCL.

Association between Medicaid expansion under the Affordable Care Act and survival among newly diagnosed cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1502-1502
Author(s):  
Xuesong Han ◽  
Jingxuan Zhao ◽  
Robin Robin Yabroff ◽  
Christopher J. Johnson ◽  
Ahmedin Jemal
Keyword(s):  
Overall Survival ◽  
Affordable Care Act ◽  
Survival Rates ◽  
Cancer Site ◽  
Cancer Type ◽  
Medicaid Expansion ◽  
Newly Diagnosed ◽  
The Affordable Care Act ◽  
One Year ◽  
Cause Specific Survival

1502 Background: Medicaid expansion under the Affordable Care Act (ACA) is associated with increased insurance coverage and early stage at diagnosis among patients with cancer. Whether these gains translate to improved survival is largely unknown, however. This study examines changes in one-year survival rates among persons newly diagnosed with cancer following the ACA Medicaid expansion. Methods: Patients aged 18-62 years from 41 population-based state cancer registries diagnosed pre-(2010-2012) and post-(2014-2016) ACA Medicaid expansion were followed through October 1, 2013 and December 31, 2016, respectively. Difference-in-differences (DD) analysis was conducted to estimate changes in one-year overall and cause-specific survival rates associated with Medicaid expansion, adjusting for age group, sex, race/ethnicity, area-level poverty, urban/rural status and region. Stratified analysis was conducted by cancer type, sex and area-level poverty. Results: A total of 2,537,818 patients diagnosed with cancer were included from Medicaid expansion (N = 1,492,729) and non-expansion (N = 1,045,089) states. During follow-up, 291,854 patients died including 246,660 deaths from cancer. The one-year overall survival rate (%) increased from 88.1 pre-ACA to 89.1 post-ACA in Medicaid expansion states and from 85.6 to 86.4 in non-expansion states for both sexes combined, resulting in a net increase of 0.4 (95%CI = 0.3-0.6) in expansion states after adjusting for sociodemographic factors. By cancer site and for both sexes combined, the increase in adjusted one-year overall survival in expansion states versus non-expansion states was greater for cancers of lung (DD = 1.6; 95%CI = 0.8-2.5), pancreas (DD = 2.2; 95%CI = 0.5-3.9) and liver (DD = 3.4; 95%CI = 1.7-5.1); as were the increases for cervix (DD = 1.3; 95%CI = 0.1-2.5), melanoma (DD = 0.4;95%CI = 0.04-0.9), non-Hodgkin lymphoma (DD = 1.2; 95%CI = 0.1-2.2) and esophagus (DD = 7.1; 95%CI = 0.5-13.7) among women. The improvement in one-year overall survival was larger among patients residing in the poorest areas (DD = 0.7; 95%CI = 0.3-1.1) compared to those in the richest areas (DD = 0.2; 95%CI = -0.2 to 0.5), leading to a narrowing survival disparity by area-level poverty. Patterns in one-year cause-specific survival were similar. Conclusions: Medicaid expansion was associated with greater increase in one-year overall survival rates, largely driven by the improvements in survival for cancer types with poor prognosis, suggesting improved access to timely and effective treatments. Furthermore, the increase was largest in poorest areas, highlighting the promising role of Medicaid expansion in reducing health disparities. Future studies should monitor changes in longer-term health outcomes following the ACA.

scholarly journals The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers

2019 ◽  
Vol 57 (6) ◽  
pp. e203-e210 ◽  
Author(s):  
J. Travis Donahoe ◽  
Edward C. Norton ◽  
Michael R. Elliott ◽  
Andrea R. Titus ◽  
Lucie Kalousová ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Affordable Care Act ◽  
Low Income ◽  
Medicaid Expansion ◽  
The Affordable Care Act

Effects of the Affordable Care Act on Health Insurance Coverage Among Middle-Aged Adults

2019 ◽  
Vol 49 (4) ◽  
pp. 712-732 ◽  
Author(s):  
Eunsun Kwon ◽  
Sojung Park ◽  
Timothy D. McBride
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Insurance Coverage ◽  
Insurance Status ◽  
Unskilled Labor ◽  
Status Change ◽  
Middle Aged ◽  
Income Status ◽  
The Affordable Care Act ◽  
Middle Aged Adults

Access to insurance coverage is challenging for middle-aged adults with higher perceived insurance needs (e.g., declining health status) and higher barriers to coverage (e.g., unstable employment and income status). Focusing on middle-aged adults, this study investigated the extent to which employment, financial, and health statuses are associated with changing patterns of insurance status following implementation of the Affordable Care Act (ACA). Seven waves (2002–2014) of the Health and Retirement Study, combined with the RAND Center for the Study of Aging data, were used. Four patterns of insurance status change emerged: constantly insured, constantly uninsured, insured after ACA, and uninsured after ACA. Compared to constantly insured, other subgroups were associated with unstable employment, unskilled labor, and part-time employment. The role of public insurance might be nearly negligible for those who were in unstable employment status and needed to shift to other forms of private coverage. More attention is needed to better understand how the insurance market functions and policy changes that could improve it. There were demographic patterns in those who remained chronically uninsured: constantly low income and poor health conditions. This suggests a much-needed practical underpinning for policymaking efforts regarding this high-risk group entering old age with catastrophic health care costs.

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