Health insurance rates among cancer survivors increased after ACA

The introduction of the Affordable Care Act was associated with an increase in health insurance among cancer survivors, but cost still remains a barrier to insurance, particularly among certain groups, research suggests.

Researchers conducted an analysis of National Health Interview Survey data from 17,806 survey participants who reported a cancer diagnosis. The findings are in JAMA Oncology.

Around one in ten of those surveyed did not have health insurance, but this rate was significantly higher before the introduction of the Affordable Care Act compared to the 3-year period after its implementation in 2014 (10.6% vs. 6.2%, P less than .001).

While cost was the most common reason for not having health insurance, the survey showed that the proportion of noninsured cancer survivors who cited cost as the reason for noninsurance decreased significantly after implementation of the Affordable Care Act (49.6% vs. 37.6%, P = .003).

Unemployment was the second-most common reason for noninsurance, but this also decreased in the 2014-2017 period compared with 2000-2013 (37.1% vs. 28.5%, P = .005).

Younger cancer survivors – aged below the mean age of 50.9 years – were 84% more likely to be uninsured, compared with those above the mean age of the study population, and those with a family income below the poverty threshold were nearly twice as likely not to be insured.

Participants of Hispanic ethnicity, noncitizens, and current smokers were significantly more likely to be uninsured.

Before the implementation of the Affordable Care Act, black patients were 29% more likely to be uninsured compared with nonblack patients. But after the ACA was introduced, this difference disappeared.

Nina N. Sanford, MD, of the University of Texas, Dallas, and coauthors wrote that, to their knowledge, this was the first study to look at reasons for noninsurance among cancer survivors, and highlighted that efforts to improve insurance coverage would require “diverse policy initiatives.

“Despite these improvements [after the Affordable Care Act], our study identified several demographic subgroups who appear to continue to be at risk for not having insurance even after the ACA, which may contribute to worse cancer-specific outcomes, decreased quality of life, and greater mortality,” they wrote. “Policymakers should be aware of these disparities when proposing legislation to either augment or limit health care coverage.”

They expressed concern about the association between smoking and a lack of health insurance, noting that the Affordable Care Act allows insurers to impose a surcharge premium on smokers. However they pointed out that this initiative has not decreased rates of smoking, and may instead have led to higher rates of noninsurance among cancer survivors who continue to smoke.

One author was supported by the American Society of Radiation Oncology and the Prostate Cancer Foundation, and one author declared funding from the pharmaceutical sector. No other conflicts of interest were declared.

SOURCE: Sanford N et al. JAMA Oncology 2019, May 15. doi: 10.1001/jamaoncol.2019.1973.

The introduction of the Affordable Care Act was associated with an increase in health insurance among cancer survivors, but cost still remains a barrier to insurance, particularly among certain groups, research suggests.

Researchers conducted an analysis of National Health Interview Survey data from 17,806 survey participants who reported a cancer diagnosis. The findings are in JAMA Oncology.

Around one in ten of those surveyed did not have health insurance, but this rate was significantly higher before the introduction of the Affordable Care Act compared to the 3-year period after its implementation in 2014 (10.6% vs. 6.2%, P less than .001).

While cost was the most common reason for not having health insurance, the survey showed that the proportion of noninsured cancer survivors who cited cost as the reason for noninsurance decreased significantly after implementation of the Affordable Care Act (49.6% vs. 37.6%, P = .003).

Unemployment was the second-most common reason for noninsurance, but this also decreased in the 2014-2017 period compared with 2000-2013 (37.1% vs. 28.5%, P = .005).

Younger cancer survivors – aged below the mean age of 50.9 years – were 84% more likely to be uninsured, compared with those above the mean age of the study population, and those with a family income below the poverty threshold were nearly twice as likely not to be insured.

Participants of Hispanic ethnicity, noncitizens, and current smokers were significantly more likely to be uninsured.

Before the implementation of the Affordable Care Act, black patients were 29% more likely to be uninsured compared with nonblack patients. But after the ACA was introduced, this difference disappeared.

Nina N. Sanford, MD, of the University of Texas, Dallas, and coauthors wrote that, to their knowledge, this was the first study to look at reasons for noninsurance among cancer survivors, and highlighted that efforts to improve insurance coverage would require “diverse policy initiatives.

“Despite these improvements [after the Affordable Care Act], our study identified several demographic subgroups who appear to continue to be at risk for not having insurance even after the ACA, which may contribute to worse cancer-specific outcomes, decreased quality of life, and greater mortality,” they wrote. “Policymakers should be aware of these disparities when proposing legislation to either augment or limit health care coverage.”

They expressed concern about the association between smoking and a lack of health insurance, noting that the Affordable Care Act allows insurers to impose a surcharge premium on smokers. However they pointed out that this initiative has not decreased rates of smoking, and may instead have led to higher rates of noninsurance among cancer survivors who continue to smoke.

One author was supported by the American Society of Radiation Oncology and the Prostate Cancer Foundation, and one author declared funding from the pharmaceutical sector. No other conflicts of interest were declared.

SOURCE: Sanford N et al. JAMA Oncology 2019, May 15. doi: 10.1001/jamaoncol.2019.1973.

The introduction of the Affordable Care Act was associated with an increase in health insurance among cancer survivors, but cost still remains a barrier to insurance, particularly among certain groups, research suggests.

Researchers conducted an analysis of National Health Interview Survey data from 17,806 survey participants who reported a cancer diagnosis. The findings are in JAMA Oncology.

Around one in ten of those surveyed did not have health insurance, but this rate was significantly higher before the introduction of the Affordable Care Act compared to the 3-year period after its implementation in 2014 (10.6% vs. 6.2%, P less than .001).

While cost was the most common reason for not having health insurance, the survey showed that the proportion of noninsured cancer survivors who cited cost as the reason for noninsurance decreased significantly after implementation of the Affordable Care Act (49.6% vs. 37.6%, P = .003).

Unemployment was the second-most common reason for noninsurance, but this also decreased in the 2014-2017 period compared with 2000-2013 (37.1% vs. 28.5%, P = .005).

Younger cancer survivors – aged below the mean age of 50.9 years – were 84% more likely to be uninsured, compared with those above the mean age of the study population, and those with a family income below the poverty threshold were nearly twice as likely not to be insured.

Participants of Hispanic ethnicity, noncitizens, and current smokers were significantly more likely to be uninsured.

Before the implementation of the Affordable Care Act, black patients were 29% more likely to be uninsured compared with nonblack patients. But after the ACA was introduced, this difference disappeared.

Nina N. Sanford, MD, of the University of Texas, Dallas, and coauthors wrote that, to their knowledge, this was the first study to look at reasons for noninsurance among cancer survivors, and highlighted that efforts to improve insurance coverage would require “diverse policy initiatives.

“Despite these improvements [after the Affordable Care Act], our study identified several demographic subgroups who appear to continue to be at risk for not having insurance even after the ACA, which may contribute to worse cancer-specific outcomes, decreased quality of life, and greater mortality,” they wrote. “Policymakers should be aware of these disparities when proposing legislation to either augment or limit health care coverage.”

They expressed concern about the association between smoking and a lack of health insurance, noting that the Affordable Care Act allows insurers to impose a surcharge premium on smokers. However they pointed out that this initiative has not decreased rates of smoking, and may instead have led to higher rates of noninsurance among cancer survivors who continue to smoke.

One author was supported by the American Society of Radiation Oncology and the Prostate Cancer Foundation, and one author declared funding from the pharmaceutical sector. No other conflicts of interest were declared.

SOURCE: Sanford N et al. JAMA Oncology 2019, May 15. doi: 10.1001/jamaoncol.2019.1973.