Impact of Dependent Coverage Provision of the Affordable Care Act on Insurance Continuity for Adolescents and Young Adults With Cancer

2020 ◽  
pp. OP.20.00330
Author(s):  
Lena E. Winestone ◽  
Lauren L. Hochman ◽  
James E. Sharpe ◽  
Elysia Alvarez ◽  
Laura Becker ◽  
...  
Keyword(s):  
Median Time ◽  
Affordable Care Act ◽  
Older Patients ◽  
Dropout Rate ◽  
Administrative Claims ◽  
Cancer Type ◽  
Control Cohort ◽  
The Affordable Care Act ◽  
Dependent Coverage ◽  
Recent Cohort

PURPOSE: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed enrollees to remain on their parents' health insurance until 26 years of age. We compared rates of insurance disenrollment among patients with cancer who were DCP-eligible at age 19 to those who were not eligible at age 19. METHODS: Using OptumLabs Data Warehouse, which contains longitudinal, real-world, de-identified administrative claims for commercial enrollees, we examined patients born between 1982 and 1993 and diagnosed with cancer between 2000 and 2015. In the recent cohort, patients who turned 19 in 2010-2012 (DCP-eligible to stay on parents’ insurance) were matched to patients who turned 19 in 2007-2009 (not DCP-eligible when turning 19). In an earlier control cohort, patients who turned 19 between 2004 and 2006 (not DCP-eligible) were matched to patients who turned 19 between 2001 and 2003 (not DCP-eligible). Patients were matched on cancer type, diagnosis date, demographics, and treatment characteristics. The time to loss of coverage was estimated using Cox models. Difference-in-difference between the recent and earlier cohorts was also evaluated. RESULTS: A total of 2,829 patients who turned 19 years of age in 2010-2012 were matched to patients who turned 19 in 2007-2009. Median time to disenrollment was 26 months for younger patients versus 22 months for older patients (hazard ratio [HR], 0.85; 95% CI, 0.80 to 0.90; P = .001). In 8,978 patients who turned 19 between 2001 and 2006, median time to disenrollment was 20 months among both younger and older patients (HR, 0.99; 95% CI, 0.94 to 1.03; P = .59). The difference between the recent cohort and the earlier control cohort was a 15% greater reduction in coverage loss ( P < .0001), favoring those turning 19 after the DCP went into effect. CONCLUSION: In the vulnerable population of adolescent and young adult cancer survivors, the ACA may have lowered the insurance dropout rate.

Impact of the Affordable Care Act on insurance for adolescents and young adults with cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18125-e18125
Author(s):  
Lena Winestone ◽  
Lauren Hochman ◽  
James Sharpe ◽  
Elysia Marie Alvarez ◽  
Laura Becker ◽  
...  
Keyword(s):  
Young Adults ◽  
Median Time ◽  
Affordable Care Act ◽  
Cox Proportional Hazards ◽  
Drop Out ◽  
Sensitivity Analyses ◽  
Cancer Type ◽  
Difference In Difference ◽  
Pediatric Cancer Patients ◽  
The Affordable Care Act

e18125 Background: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed young adults to remain on their parents' health insurance until age 26 years (y), whereas pre-DCP the cut-off varied, but was most often 18 y. Our objective was to compare rates of insurance disenrollment among patients with cancer who were DCP-eligible compared to those who were not. Methods: A retrospective cohort from the OptumLabs Data Warehouse, which includes claims data for privately insured enrollees in a large US health plan, was used. Patients born between 1982-93 diagnosed with cancer between 2000-15 were included. In the Recent Cohort, patients who turned 19 in 2010-12 (who were always eligible to stay on parents’ insurance) were matched to patients who turned 19 in 2007-09 (who were not protected by the DCP when they turned 19). Sensitivity analyses paired patients in an Earlier Cohort, who turned 19 (in 2001-03 and 2004-06), none of whom were eligible for the DCP when they turned 19. Patients were matched on cancer type, diagnosis date, and additional clinical characteristics. Using a time to loss of coverage analysis (defined as > 90 d interruption in insurance enrollment), hazard ratios (HR) were calculated using Cox proportional hazards models. Difference-in-difference between pairs from the Recent and Earlier cohorts was evaluated. Results: Of the 3,013 patients who turned 19 in 2010-12, 2,829 were matched. Median time to disenrollment was 26 months (m) compared to 22 m among patients who turned 19 in 2007-09 (HR 0.88, 95% CI 0.81-0.95, p = 0.0009). In the 4,489 pairs of patients who turned 19 between 2001-06, median time to disenrollment was 20 m among both the younger and older patients in the pair (p = 0.047). In grouped analyses, the difference-in-difference between the Recent and Earlier sets of pairs displayed a 14% reduction in the hazard for losing coverage (p < 0.0001), favoring those who turned 19 after DCP became available. Conclusions: In pediatric cancer patients and survivors, a vulnerable population that needs continuous insurance coverage, these data suggest that the DCP of the ACA lowers the insurance drop-out rate.

Impacts of the Affordable Care Act Dependent Coverage Provision on Young Adults With Cancer

2019 ◽  
Vol 56 (5) ◽  
pp. 716-726 ◽  
Author(s):  
Justin M. Barnes ◽  
Jenine K. Harris ◽  
Derek S. Brown ◽  
Allison King ◽  
Kimberly J. Johnson
Keyword(s):  
Young Adults ◽  
Affordable Care Act ◽  
The Affordable Care Act ◽  
Dependent Coverage

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 effect of the affordable care act dependent coverage provision on patients with cystic fibrosis

2017 ◽  
Vol 52 (4) ◽  
pp. 458-466 ◽  
Author(s):  
Dmitry Tumin ◽  
Susan S. Li ◽  
Benjamin T. Kopp ◽  
Stephen E. Kirkby ◽  
Joseph D. Tobias ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Affordable Care Act ◽  
The Affordable Care Act ◽  
Dependent Coverage

scholarly journals Association Between the Affordable Care Act Dependent Coverage Expansion and Cervical Cancer Stage and Treatment in Young Women

JAMA ◽  
2015 ◽  
Vol 314 (20) ◽  
pp. 2189 ◽  
Author(s):  
Anthony S. Robbins ◽  
Xuesong Han ◽  
Elizabeth M. Ward ◽  
Edgar P. Simard ◽  
Zhiyuan Zheng ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Young Women ◽  
Affordable Care Act ◽  
Cancer Stage ◽  
Coverage Expansion ◽  
The Affordable Care Act ◽  
Dependent Coverage
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