Did ACA Benefit Cancer Patients?

A new analysis evaluated the effects of the Affordable Care Act (ACA) on insurance coverage for patients with head and neck cancer. The researchers here concluded that the ACA reduced the percentage of uninsured patients, particularly among young adults and residents of low-income zip codes.

Regarding the significance of their study, the authors wrote, “Health insurance status has a significant association with early diagnosis and stage at presentation, which are the most important predictors of survival among patients with head and neck cancer (HNC). Literature on the association of the Patient Protection and Affordable Care Act (ACA) with changes in insurance status among patients with HNC remains limited. To our knowledge, no studies have evaluated changes in insurance rates across sociodemographic subgroups of patients with HNC.”

The findings were published in JAMA Otolaryngology–Head & Neck Surgery.

The researchers conducted their retrospective cohort study by querying the National Cancer Database (NCDB) for data spanning 2011–2015 on adults diagnosed with a malignant primary head and neck cancer. The primary outcome measure was changes in the percentage of patients with insurance.

Final analysis included 131,779 head and neck cancer patients: pre-ACA, n = 77,071; post-ACA, n = 54,708. The study cohort was majority-male (n = 98,207, 74.5%); more than half (n = 73,124, 55.5%) of patients were aged 50–64 years. From the period before and after the ACA was implemented, the researchers observed a 2.68 percentage point decrease (PPD) (95% CI, 2.93–2.42) in the percentage of head and neck cancer patients without insurance. Insured status varied largely by age, the authors noted, “with the largest reduction in uninsured status among patients with HNC aged 18 to 34 years (5.12 PPD; 95% CI, 3.18-7.06) and the smallest reduction in uninsured among those aged 65 to 74 years (0.24 PPD; 95% CI, 0.03-0.45).” Uninsured reductions also varied significantly between low-income (3.45 PPD; 95% CI, 2.76-4.14) versus high-income (1.99 PPD; 95% CI, 1.63-2.36) zip codes.

The researchers concluded that the implementation of the ACA was significantly associated with a percentage decrease in uninsured patients, with young adults and residents of low-income zip codes experiencing the most significant insurance uptake rate compared to older adults and those living in high-income zip codes.

“This suggests that coverage expansions enacted through the ACA are not only associated with increased access to care among the broader [head and neck cancer] population, but that they may also yield a greater benefit among subpopulations with historically limited insurance coverage,” posited the authors.