The impact of the Affordable Care Act on treatment of testicular cancer.

422 Background: The passage of the Affordable Care Act (ACA) in 2010 aimed to improve access for uninsured patients to private health insurance. Yet, the impact of the ACA on the number of privately insured young patients and on the timeliness of medical care for serious medical conditions, remain unclear. Thus, we sought to ascertain changes in insurance status and evaluate timeliness of post-orchiectomy definitive therapy for young men diagnosed with testicular cancer following passage of the ACA. Methods: From the National Cancer Database, we identified all patients 18 – 50 years of age diagnosed with stages I – III testicular cancer from 2007 to 2013. Patients were divided into groups at the time of diagnosis; 2007 – 2009 (pre-ACA) and 2011 to 2013 (post-ACA). Only patients who had undergone radical orchiectomy and had a reported insurance status were included in analysis. The primary outcomes were insurance type at diagnosis and time to treatment of secondary therapy following orchiectomy (systemic chemotherapy, radiation therapy, or surgery {Retroperitoneal lymph node dissection; RPLND}). Results: Overall, 17,945 patients were included in analysis with 53.5% diagnosed with pure seminoma and 46.5% diagnosed with nonseminomatous germ cell tumor (NSGCT). In comparing pre- and post-ACA cohorts, the percentage of patients with private health insurance decreased following the passage of the ACA (74.1% vs. 71.2%; p < 0.01). Similarly, the percentage of patients without any insurance increased between the two time frames (12.7 % vs. 13.4%; p < 0.01). More patients presented with clinical stage II and III disease following the passage of the ACA (28.9% vs. 31.9%; p < 0.01). Compared to patients without health insurance, privately insured patients received more timely secondary definitively therapy with radiation therapy (49.9 vs. 60.9 days, p < 0.01) and chemotherapy (41.5 vs. 45.7 days, p < 0.01) but no difference in the time to RPLND (18.8 vs. 16.7 days, p = 0.70). Conclusions: The impact of the ACA on patients with testicular cancer shows minimal worsening in the number of privately insured young men and increasing rates of advanced testis cancer. This was not in agreement with our hypothesis and suggests the ACA is not benefiting young men with this malignancy.