Insurance coverage, stage at diagnosis, and time to treatment following dependent coverage and Medicaid expansion for men with testicular cancer

Abstract

Introduction We sought to assess the impact of Affordable Care Act Dependent Care Expansion (ACA-DCE), which allowed dependent coverage for adults aged 19–25, and Medicaid expansion on outcomes for men with testicular cancer. Methods Using a US-based cancer registry, we performed adjusted difference-in-difference (DID) analyses comparing outcomes between men aged 19–25 (n = 8,026) and 26–64 (n = 33,303) pre- (2007–2009) and post-ACA-DCE (2011–2016) and between men in states that expanded Medicaid (n = 2,296) to men in those that did not (n = 2,265)pre- (2011–2013) and post-Medicaid expansion (2015–2016). Results In ACA-DCE analysis, rates of uninsurance decreased (DID -5.64, 95% confidence interval [CI] -7.23 to -4.04%, p<0.001) among patients aged 19–25 relative to older patients aged 26–64. There was no significant DID in advanced stage at diagnosis (stage≥II; p = 0.6) or orchiectomy more than 14 days after diagnosis (p = 0.6). For patients who received chemotherapy or radiotherapy as their first course of treatment, treatment greater than 60 days after diagnosis decreased (DID -4.84%, 95% CI -8.22 to -1.45%, p = 0.005) among patients aged 19–25 relative to patients aged 26–64. In Medicaid expansion states, rates of uninsurance decreased (DID -4.20%, 95% CI -7.67 to -0.73%, p = 0.018) while patients receiving chemotherapy or radiotherapy greater than 60 days after diagnosis decreased (DID -8.76, 95% CI -17.13 to -0.38%, p = 0.040) compared to rates in non-expansion states. No significant DIDs were seen for stage (p = 0.8) or time to orchiectomy (p = 0.1). Conclusions Men with testicular cancer had lower uninsurance rates and decreased time to delivery of chemotherapy or radiotherapy following ACA-DCE and Medicaid expansions. Time to orchiectomy and stage at diagnosis did not change following either insurance expansion.

Acceptance of Simulated Adult Patients With Medicaid Insurance Seeking Care in a Cancer Hospital for a New Cancer Diagnosis

“…To date, key estimates of ACA-related effects have been drawn from the National Cancer Database, a hospital registry source aggregating data from CoC-accredited hospitals and capturing approximately 70% of cancer care delivered in the United States. 8 , 27 , 28 , 29 From this perspective, our study, focused at the level of patient access, reveals significant barriers to entry at CoC hospitals and indicates potential sources of representation bias by the systematic exclusion of patients with Medicaid at certain institutions. Insurance status overlaps heavily with other sources of sociodemographic disparities in cancer care.…”

“…1 As Medicaid has long been an essential source of coverage for low-income, nonelderly US adults with cancer, implementation of the ACA has also led to increases in insurance rates, screening, and access to treatment. 2 , 3 , 4 , 5 , 6 , 7 , 8 Coverage has notably increased for historically disadvantaged populations of patients with cancer, including members of racial and ethnic minority groups, those residing in rural areas, and individuals with lower educational levels. 4 , 9 Despite improvements attributable to ACA expansion, infrastructural and financial constraints remain obstacles to timely and universal care.…”

Evaluation of Insurance Coverage and Cancer Stage at Diagnosis Among Low-Income Adults With Renal Cell Carcinoma After Passage of the Patient Protection and Affordable Care Act

“…Insurance and Cancer Stage at Diagnosis Among Low-Income Adults With RCC After ACA Passage well as that of Weiner et al, 18 as opposed to that of Hsiang et al, 12 and suggest that older groups may derive more benefit.…”

Sociodemographic characteristics and cervical cancer survival in different regions of the United States: a National Cancer Database study

“…While most of the current study’s cohort was diagnosed prior to this broad implementation, this is a useful context in which to consider the data and suggest regional solutions. Furthermore, Medicaid expansion has already been associated with more expeditious oncologic care in gynecologic, testicular, bone, and soft tissue malignancies 22–24…”