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The Patient Protection and Affordable Care Act dependent coverage expansion: Disparities in impact among young adult oncology patients
Author(s) -
Alvarez Elysia M.,
Keegan Theresa H.,
Johnston Emily E.,
Haile Robert,
Sanders Lee,
Wise Paul H.,
Saynina Olga,
Chamberlain Lisa J.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30978
Subject(s) - medicine , confidence interval , odds ratio , patient protection and affordable care act , ethnic group , population , demography , odds , medicaid , health insurance , private insurance , young adult , gerontology , logistic regression , health care , environmental health , sociology , anthropology , economics , economic growth
BACKGROUND Private health insurance is associated with improved outcomes in patients with cancer. However, to the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA‐DCE), which extended private insurance to young adults (to age 26 years) beginning in 2010, on the insurance status of young adults with cancer. METHODS The current study was a retrospective, population‐based analysis of hospitalized young adult oncology patients (aged 22‐30 years) in California during 2006 through 2014 (11,062 patients). Multivariable regression analyses examined factors associated with having private insurance. Results were presented as adjusted odds ratios and 95% confidence intervals. A difference‐in‐difference analysis examined the influence of the ACA‐DCE on insurance coverage by race/ethnicity and federal poverty level. RESULTS Multivariable regression demonstrated that patients of black and Hispanic race/ethnicity were less likely to have private insurance before and after the ACA‐DCE, compared with white patients. Younger age (22‐25 years) was associated with having private insurance after implementation of the ACA‐DCE (odds ratio, 1.20; 95% confidence interval, 1.06‐1.35). In the difference‐in‐difference analysis, private insurance increased among white patients aged 22 to 25 years who were living in medium‐income (2006‐2009: 64.6% vs 2011‐2014: 69.1%; P = .003) and high‐income (80.4% vs 82%; P = .043) zip codes and among Asians aged 22 to 25 years living in high‐income zip codes (73.2 vs 85.7%; P = .022). Private insurance decreased for all Hispanic patients aged 22 to 25 years between the 2 time periods. CONCLUSIONS The ACA‐DCE provision increased insurance coverage, but not among all patients. Private insurance increased for white and Asian patients in higher income neighborhoods, potentially widening social disparities in private insurance coverage among young adults with cancer. Cancer 2018;124:110‐7 . © 2017 American Cancer Society .