The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years

Abstract

Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care than their counterparts with health insurance coverage. On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law, representing the largest change to health care delivery in the United States since the introduction of the Medicare and Medicaid programs in 1965. The primary goals of the ACA are to improve health insurance coverage, the quality of care, and patient outcomes, and to maintain or lower costs by catalyzing changes in the health care delivery system. In this review, we describe the main components of the ACA, including health insurance expansions, coverage reforms, and delivery system reforms, provisions within these components, and their relevance to cancer screening and early detection, care, and outcomes. We then highlight selected, well-designed studies examining the effects of the ACA provisions on coverage, access to cancer care, and disparities throughout the cancer control continuum. Finally, we identify research gaps to inform evaluation of current and emerging health policies related to cancer outcomes. CA Cancer J Clin 2020;70:165-181.

Association Between Medicaid Expansion and Diagnosis and Management of Colon Cancer

“…Although this study found an increase in stage I diagnoses as a result of Medicaid expansion, earlier reports on this topic have conflicting results. 4,9 Soni and colleagues 8 found more early-stage diagnoses in a heterogeneous cohort of malignancies. When analyzing the NCDB for the years 2011-2014, Jemal and colleagues 5 found increased early-stage colorectal cancer in Medicaid expansion states, but this was not significant on adjusted analyses.…”

“…Early reports have suggested that cancer screening and early diagnosis have improved with Medicaid expansion, but some of the findings are inconsistent. [4][5][6][7][8][9][10][11] Colon cancer is a disease that can be particularly affected by access to care, given its high prevalence and effective screening protocols. In addition, nearly one-half of cases occur in patients younger than 65 years and the incidence among younger adults has been increasing in recent years.…”

Long non‑coding RNA B4GALT1‑Antisense RNA 1/microRNA‑30e/SRY‑box transcription factor 9 signaling axis contributes to non‑small cell lung cancer cell growth

“…Lung cancer (LCa) remains one of the primary reasons of cancer mediated fatalities globally, with 5-year survival rates of <20% in 2017 (1). In the US ~234,030 new LCa cases were diagnosed and in China ~781,500 new LCa cases were diagnosed in 2018 (2). Non-small cell lung cancer (NSCLC) is the most prevalent subtype of lung cancer, and lung adenocarcinoma (LUAD) is the major subtype of NSCLC (3).…”

Medicaid expansion and the management of pancreatic cancer

“…Some studies have found increased screening and early-stage diagnosis, but these findings are at times small or inconsistent. [7][8][9][10][11][12] Findings specific to pancreatic cancer have also been mixed. One national study found no difference in early stage diagnoses in the years immediately following insurance expansion.…”