Details:

Alternative Title:
Med Care
Publisher's site:
http://dx.doi.org/10.1097/MLR.0000000000000876
Personal Author:
Davidoff, Amy J. ; Guy, Gery P. ; Hu, Xin ; Gonzales, Felisa ; Han, Xuesong ; ... More +
Davidoff, Amy J. ; Guy, Gery P. ; Hu, Xin ; Gonzales, Felisa ; Han, Xuesong ; Zheng, Zhiyuan ; Parsons, Helen ; Ekwueme, Donatus U. ; Jemal, Ahmedin Less -
Description:
Background:

The Affordable Care Act (ACA) improved health care coverage accessibility by expanding Medicaid eligibility, creating insurance Marketplaces, and subsidizing premiums. We examine coverage changes associated with ACA implementation, comparing adults with and without a cancer history.

Methods:

We included nonelderly adults from the 2012 to 2015 National Health Interview Survey. Using information on state Medicaid policies (2013), expansion decisions (2015), family structure, income, insurance offers, and current coverage, we assigned adults in all 4 years to mutually exclusive eligibility categories including: Medicaid-eligible pre-ACA; expansion eligible for Medicaid; and Marketplace premium subsidy eligible. Linear probability regressions estimated pre-post (2012–2013 vs. 2014–2015) coverage changes by eligibility category, stratified by cancer history.

Results:

The uninsured rate for cancer survivors decreased from 12.4% to 7.7% (P < 0.001) pre-post ACA implementation. Relative to income > 400% of the federal poverty guideline, the uninsured rate for cancer survivors decreased by an adjusted 8.4 percentage points [95% confidence interval (CI), 1.3–15.6] among pre-ACA Medicaid eligible; 16.7 percentage points (95% CI, 9.0–24.5) among expansion eligible, and 11.3 percentage points (95% CI, −0.8 to 23.5, with a trend P = 0.069) for premium subsidy eligible. Decreases in uninsured among expansion-eligible adults without a cancer history [9.7 percentage points (95% CI, 7.4–12.0), were smaller than for cancer survivors (with a trend, P = 0.086)]. Despite coverage gains, ~528,000 cancer survivors and 19.1 million without a cancer history remained uninsured post-ACA, yet over half were eligible for Medicaid or subsidized Marketplace coverage.

Conclusions:

ACA implementation was associated with large coverage gains in targeted expansion groups, including cancer survivors, but additional progress is needed.


Keywords:
[+]
Adult Cancer Survivors Eligibility Eligibility Determination Female Health Care Reform Humans Insurance Insurance, Health Insurance Coverage Male Medicaid Middle Aged Patient Protection And Affordable Care Act Surveys And Questionnaires United States
Source:
Med Care. 56(3):220-227
Pubmed ID:
29438192
Pubmed Central ID:
PMC6105312
Document Type:
Journal Article
Funding:
CC999999/Intramural CDC HHSUnited States/
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:6d48ebfa9d647c46eadee7df40ceca13490799463b29ddc55e584f4b9a938e27
Download URL:
https://stacks.cdc.gov/view/cdc/58367/cdc_58367_DS1.pdf
File Type:

Supporting Files

• 	nihms-983838-f0001.gif	gif
  	nihms-983838-f0001.jpg	jpeg
  	nihms-983838.nxml	xml
  	NIHMS983838-supplement-Appendix.pdf	pdf

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