Large decrease in uninsured new cancer patients linked to Affordable Care Act

(Reuters Health) - The number of newly diagnosed cancer patients without health insurance declined by one-third in 2014, which is likely an effect of the Affordable Care Act (ACA), a small study suggests.

“Either the impact of the ACA was that people who were now insured had access to screening services that uncovered cancer, or people who knew they had cancer came forward. Their journey was at least less stressful because they were covered and had access to care,” Dr. Clifford A. Hudis, chief executive officer of the American Society of Clinical Oncology, told Reuters Health by phone.

“My only wish is that the evidence in this study would have some positive impact and influence the current debate about the potential rollback of a provision that might have given us some gains,” said Hudis, who wasn’t involved in the study.

Starting in January 2014, the ACA - commonly called Obamacare - expanded Medicaid coverage and provided subsidies so nonelderly Americans could buy affordable health insurance. It led to historic gains in the number of people covered by health insurance.

For the analysis, published online October 19 in JAMA Oncology, researchers used the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database to analyze the percentages of uninsured patients with newly diagnosed cancers from 2010 to 2014.

Overall, they looked at data on more than 858,000 adults, ages 19 to 64, in 13 states. The states include 28% of the population and are representative of national demographics, said lead author Aparna Soni, a doctoral candidate in business economics and public policy at Indiana University in Bloomington.

Nine states in the study participated in the ACA’s Medicaid expansion program; the other four did not.

In 2014, after ACA was implemented, the uninsured rate remained unchanged in states in the SEER database without Medicaid expansion but “declined sharply” in expansion states, Soni’s team reports.

Overall, the proportion of new cancer patients who were uninsured fell to 3.8% from 5.7% in the preceding three years – a decrease of about 16,500 people, or 33%.

Lack of insurance has been linked with late cancer diagnosis, poorer treatment and poor survival, said Ahmedin Jemal, vice president for surveillance and health services research at the American Cancer Society.

“We can’t underestimate the importance of the Medicaid program which provides timely access to cancer care,” Jemal said.

The study found significant gains in insurance coverage across many ethnic and demographic groups, as well as numerous stages and types of common cancers, including colorectal, prostate, thyroid, breast and lung and bronchial cancers.

The proportion of newly diagnosed cancer patients without insurance dropped by 39.9% among adults of Hispanic ethnicity and by 46.2% among “other” ethnicities.

By cancer type, the largest decrease in percent uninsured – a drop of 32.7% - occurred in patients with lung and bronchial cancer. There was a 33.3% decline in uninsured patients with cancer that had spread to other places in the body.

Soni pointed out in a phone interview that although the research didn’t examine the effect of insurance coverage on cancer diagnosis, people without insurance coverage are more likely to wait and see their physician only when they can’t ignore their symptoms so they are more likely to be diagnosed with late-stage cancer.

“Cancer treatment is very expensive. Without insurance it is unaffordable. Insurance status determines the type of treatment someone can afford,” Soni said.

The study only included data from 13 states and tracked insurance coverage for only one year after the ACA was implemented.

Soni said there could be further decreases in uninsured adults with new cancer diagnoses during the remaining years of the program.