The influence of the Affordable Care Act-Dependent Care Expansion on insurance coverage among young cancer survivors in California: an updated analysis

Renata Abrahão, Frances B. Maguire, Cyllene R. Morris, Arti Parikh-Patel, Helen M. Parsons, Theresa H.M. Keegan

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To assess changes in health insurance coverage for young cancer patients pre- and post- the Affordable Care Act-Dependent Care Expansion (ACA-DCE) implementation in California. Further, we examined differences in insurance coverage by socioeconomic and race/ethnicity. Methods: Data were obtained from the California Cancer Registry and Medicaid enrollment files, from 2005 to 2014. We conducted difference-in-difference analyses among 7042 cancer patients aged 22–25 years (“intervention group”) and 25,269 aged 26–34 years (“control group”). We also examined the independent and combined effects of race/ethnicity and neighborhood socioeconomic status (nSES) on insurance coverage. Results: After the ACA-DCE implementation, we observed a 52.7% reduction in the proportion of uninsured and a 35.7% increase in the proportion of privately insured patients. There was also a 17.3% reduction in Medicaid at cancer diagnosis and a 27.5% reduction in discontinuous Medicaid enrollment. However, these benefits were limited to patients of non-Hispanic White, Hispanic and Asian/Pacific Islander race/ethnicity living in higher nSES, with no differences in insurance enrollment among young adults who lived in low nSES or those of Black race/ethnicity. Conclusion: The ACA-DCE broadened insurance coverage for young adults with cancer in California. Yet, only certain subgroups of patients have benefited from this policy.

Original languageEnglish (US)
JournalCancer Causes and Control
DOIs
StateAccepted/In press - 2020

Keywords

  • ACA-DCE
  • Cancer
  • Insurance coverage
  • Medicaid
  • Population-based study
  • Young adult

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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