The Affordable Care Act improved health insurance coverage and cardiovascular‐related screening rates for cancer survivors seen in community health centers

Abstract

BACKGROUND: This study assessed the impact of Affordable Care Act (ACA) Medicaid expansion on health insurance rates and receipt of cardiovascular-related preventive screenings (body mass index, glycated hemoglobin [HbA1c], low-density lipoproteins, and blood pressure) for cancer survivors seen in community health centers (CHCs). METHODS: This study identified cancer survivors aged 19 to 64 years with at least 3 CHC visits in 13 states from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). Via inverse probability of treatment weighting multilevel multinomial modeling, insurance rates before and after the ACA were estimated by whether a patient lived in a state that expanded Medicaid, and changes between a pre-ACA time period and 2 post-ACA time periods were assessed. RESULTS: The weighted estimated sample size included 409 cancer survivors in nonexpansion states and 2650 in expansion states. In expansion states, the proportion of uninsured cancer survivors decreased significantly from 20.3% in 2012-2013 to 4.5%in 2016-2017, and the proportion of those with Medicaid coverage increased significantly from 38.8% to 55.6%. In nonexpansion states, there was a small decrease in uninsurance rates (from 33.6% in 2012-2013 to 22.5% in 2016-2017). Cardiovascularrelated preventive screening rates increased over time in both expansion and nonexpansion states: HbA1c rates nearly doubled from the pre-ACA period (2012-2013) to the post-ACA period (2016-2017) in expansion states (from 7.2% to 12.8%) and nonexpansion states (from 9.3% to 16.8%). CONCLUSIONS: This study found a substantial decline in uninsured visits among cancer survivors in Medicaid expansion states. Yet, 1 in 5 cancer survivors living in a state that did not expand Medicaid remained uninsured. Several ACA provisions likely worked together to increase cardiovascular-related preventive screening rates for cancer survivors seen in CHCs.

Access to Care, Cost of Care, and Satisfaction With Care Among Adults With Private and Public Health Insurance in the US

“…Fifth, comorbid conditions and functional status were also self-reported; however, the reliability and validity of BRFSS data on medical conditions have been previously validated. 2 Sixth, the heterogeneity of coverage within each insurance category in both private and public programs was not uniform and varied in terms of benefits by employer, plan, and state and may have confounded our findings.…”

“…To assess the type of coverage, we used the question, "What is the primary source of your health care coverage?" The response options included the following: (1) plan purchased through an employer or union; (2) (8) no coverage. If the respondents indicated that they purchased insurance through the Health Insurance Marketplace, they were then asked whether it was a private plan purchased on their own or by a family member or whether they received Medicaid (public plan).…”

“…The ACA has expanded access to care and has been associated with improvements in self-reported health and reductions in mortality among previously uninsured US adults. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 …”

“…The ACA has expanded access to care and has been associated with improvements in self-reported health and reductions in mortality among previously uninsured US adults. [1][2][3][4][5][6][7][8][9][10][11] As a result of the ACA, the number of both Medicaid and individually purchased private insurance coverage options has increased, whereas the number of employer-sponsored insurance options has decreased. 12 In recent years, policy makers have called for legislation that would further expand coverage, with proposals including developing a public option, reducing the Medicare eligibility age to 50 years, and expanding Medicare coverage to all US adults.…”

Disparities in health care affordability among childhood cancer survivors persist following the Affordable Care Act

“…20 Non-expansion states saw slower rates of decline. In 2012-2013, it was 33.6%, declining to 20.3% in 2014-2015 before increasing to 22.5% in 2016-2017.…”