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The impact of the Patient Protection and Affordable Care Act on insurance coverage and cancer‐directed treatment in HIV‐infected patients with cancer in the United States
Author(s) -
Corrigan Kelsey L.,
Nogueira Leticia,
Yabroff K. Robin,
Lin Chun Chieh,
Han Xuesong,
Chino Junzo P.,
Coghill Anna E.,
Shiels Meredith,
Jemal Ahmedin,
Suneja Gita
Publication year - 2020
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.32563
Subject(s) - medicaid , medicine , receipt , patient protection and affordable care act , cancer , health insurance , demography , health care , family medicine , gerontology , environmental health , sociology , world wide web , computer science , economics , economic growth
Background To the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act (ACA) on people living with HIV and cancer (PLWHC), who have lower cancer treatment rates and worse cancer outcomes. To investigate this research gap, the authors examined the effects of the ACA on insurance coverage and receipt of cancer treatment among PLWHC in the United States. Methods HIV‐infected individuals aged 18 to 64 years old with cancer diagnosed between 2011 and 2015 were identified in the National Cancer Data Base. Health insurance coverage and cancer treatment receipt were compared before and after implementation of the ACA in non–Medicaid expansion and Medicaid expansion states using difference‐in‐differences analysis. Results Of the 4794 PLWHC analyzed, approximately 49% resided in nonexpansion states and were more often uninsured (16.7% vs 4.2%), nonwhite (65.2% vs 60.2%), and of low income (36.3% vs 26.9%) compared with those in Medicaid expansion states. After 2014, the percentage of uninsured individuals decreased in expansion states (from 4.9% to 3%; P = .01) and nonexpansion states (from 17.6% to 14.6%; P = .06), possibly due to increased Medicaid coverage in expansion states (from 36.9% to 39.2%) and increased private insurance coverage in nonexpansion states (from 29.5% to 34.7%). There was no significant difference in cancer treatment receipt noted between Medicaid expansion and nonexpansion states. However, the percentage of PLWHC treated at academic facilities increased significantly only in expansion states (from 40.2% to 46.7% [ P < .0001]; difference‐in‐differences analysis: 7.2 percentage points [ P = .02]). Conclusions The implementation of the ACA was associated with improved insurance coverage among PLWHC. Lack of insurance still is common in non–Medicaid expansion states. Patients with minority or low socioeconomic status more often resided in nonexpansion states, thereby highlighting the need for further insurance expansion.