Racial/Ethnic Disparities in Health and Life Insurance Denial Due to Cancer among Cancer Survivors

Abstract

This study examined racial/ethnic differences in health/life insurance denial due to cancer among cancer survivors after the passage of the Affordable Care Act (ACA). Behavioral Risk Factor Surveillance System data were obtained from 2012–2020. The dependent variable asked: “Were you ever denied health insurance or life insurance coverage because of your cancer?” Cancer survivors were included if they were diagnosed with cancer after the Affordable Care Act (N = 14,815). Unadjusted and adjusted logistic regressions for age, sex, income, and employment provided odds ratios of insurance denial due to cancer across racial/ethnic groups: Non-Hispanic White, Black, and Other/mixed race; and Hispanic. Statistically significant differences (p < 0.05) were found between those who were denied or not denied insurance across sex, age, race/ethnicity, income, and employment. Adjusted regressions found significantly higher odds ratios of insurance denial for Blacks (OR: 3.00, 95% CI: 1.77, 5.08), Other/mixed race (OR: 2.16, 95% CI: 1.16, 4.02), and Hispanics (OR: 2.13, 95% CI: 1.02, 4.42) compared to Whites. Differences were observed across sex, income, and employment. Cancer survivors report racial/ethnic disparities in health and life insurance denial due to their cancer despite policy changes. This may be harmful for those who are already financially vulnerable due to their cancer diagnosis and exacerbate racial/ethnic cancer disparities.

Racial disparities in Black men with prostate cancer: A literature review

“…Inaccurate biologic differences between races, e.g., higher pain thresholds and reduced risk of injury, were published in medical journals, legitimizing ill‐informed medical judgements 18 . The racism that intertwines the foundations of medical society is evident in the modern day through denial of health and life insurance coverage among Black families with incomes <$75,000 and lower socioeconomic status (SES), leading to lower health care access and resources, ultimately resulting in the underdiagnosis and/or misdiagnosis of cancer 5,19,20 …”

“…18 The racism that intertwines the foundations of medical society is evident in the modern day through denial of health and life insurance coverage among Black families with incomes <$75,000 and lower socioeconomic status (SES), leading to lower health care access and resources, ultimately resulting in the underdiagnosis and/or misdiagnosis of cancer. 5,19,20…”

Racial and Ethnic Disparities in Survival Among People With Second Primary Cancer in the US

“…Development of these guidelines should consider various challenges faced by persons with multiple primary cancers, such as balancing the benefits and harms of intensive cancer screening, limited treatment options concerning drug resistance and contraindication, the possibility of underlying factors associated with cancer, multiple chronic morbidities, the complexity in navigating health care systems (multiple referrals and care transitions between care settings and health care practitioners), and exacerbated financial hardship . Issues of financial hardship may be particularly relevant to the observed racial and ethnic disparities in SPC survival, as prior cancer-related disruptions and employment consequences are disproportionately experienced by racial and ethnic minority groups, with the Black and Hispanic populations being significantly more likely to be denied health insurance due to a prior cancer diagnosis compared with the non-Hispanic White population …”

“… 76 Issues of financial hardship may be particularly relevant to the observed racial and ethnic disparities in SPC survival, as prior cancer-related disruptions and employment consequences are disproportionately experienced by racial and ethnic minority groups, 77 with the Black and Hispanic populations being significantly more likely to be denied health insurance due to a prior cancer diagnosis compared with the non-Hispanic White population. 77 , 78 …”

U.S. Black adults' estate planning: The role of financial planner use, inheritance receipt, and life insurance ownership

“…Existing literature presents varying findings regarding racial disparities in life insurance ownership and death benefits. Black families have faced exclusion in the life insurance space with Black households having a higher rate of being denied life insurance even into the 21st century (Lent et al, 2022). There is evidence that Black consumers have systematically been offered policies with lower values than Whites (Wright-Mendoza, 2018).…”