In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 35, No. 15_suppl ( 2017-05-20), p. 6527-6527
Kurzfassung:
6527 Background: Beginning in 2014, Medicaid eligibility was expanded in over half of states, enrollment was simplified, and insurance marketplaces were created in all states with premium subsidies for selected individuals, as a result of implementation of the Affordable Care Act (ACA). We examine changes in insurance coverage for cancer survivors overall, and for targeted subgroups affected by specific ACA elements. Methods: We pooled data for cancer survivors aged 19-64 years from the 2012-2015 National Health Interview Survey. Using information on family structure, income, and employment, and linked state-specific Medicaid eligibility policies, we assigned survivors to 3 targeted groups: 1) Medicaid eligible pre-ACA; 2) Medicaid expansion eligible; 3) eligible for premium tax credits for Marketplace plans; and 3 groups not targeted for benefit: a) eligibility gap (income 〈 100% federal poverty level (FPL) in states not expanding Medicaid); b) with alternative “affordable” coverage; and c) high income ( 〉 400% FPL). Linear probability regressions examined pre(2012-13)/post(2014-15) coverage changes by eligibility category, adjusting for demographic characteristics. Results: Among 4,115 (wtd N = 6.90M) cancer survivors, insurance pre-ACA was 69% private, 15.2% public, and 12.2% uninsured. Post-ACA, overall public coverage increased by 3.2 percentage points (pct pt) (p = .036), whereas the percent uninsured decreased by 4.5 pct pt (p 〈 .001). Relative to the high income category, the adjusted percent uninsured decreased by 8.4 pct pt (95% CI:1.2-15.5) among pre-ACA Medicaid eligible, by 16.7 pct pt (95% CI:8.9-24.4) among the newly Medicaid eligible, and by 11.3 pct pt (95% CI:1.0-23.4; p = .069) among premium subsidy eligible. No coverage gains were observed for the other 2 categories. Approximately 531,000 cancer survivors remained uninsured after ACA implementation, with over half eligible for either Medicaid (12%) or subsidized Marketplace plans (44%). Conclusions: In the first 2 years post-ACA, cancer survivors experienced substantial increases in insurance coverage, with changes limited to targeted subgroups. Over half of remaining uninsured were eligible for coverage.
Materialart:
Online-Ressource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/JCO.2017.35.15_suppl.6527
Sprache:
Englisch
Verlag:
American Society of Clinical Oncology (ASCO)
Publikationsdatum:
2017
ZDB Id:
2005181-5
