Younger cancer survivors less likely to face financial barriers to care after ACA
Financial barriers to health care decreased significantly after implementation of the Affordable Care Act among adult cancer survivors aged younger than 65 years, according to study results published in JCO Oncology Practice.
In addition, researchers observed reductions in the inability to afford medical treatment, medications and health insurance among survivors in this age group.
“With each passing year after implementation of the major provisions of the Affordable Care Act in 2014, we believe the data are now mature enough to make an updated and clear assessment of its impact on financial barriers in the cancer survivor population, stratified by Medicare eligibility at age 65 [years],” Christopher T. Su, MD, MPH, clinical fellow in the division of hematology and oncology at University of Michigan, told Healio. “Early studies on the impact of the ACA on [patients with cancer] were limited in this regard and often compared patients with cancer against those who did not have cancer. We wondered: What was the difference in financial barriers faced by cancer survivors before and after implementation of the ACA, and how was this different between the [aged] younger than 65 years and [aged] older than 65 years Medicare-eligible groups?”
Researchers identified 21,954 cancer survivors included in the National Health Interview Survey between 2009 and 2018. These included 9,228 survivors aged 18 to 64 years and 12,726 aged older than 65 years.
Survivors completed a survey that included questions about financial barriers to medical care and medications. Researchers compared responses between the 5 years before ACA implementation (2009-2013) and the 5 years after ACA implementation (2014-2018). They then performed age-stratified multivariable logistic regression modeling that adjusted for demographic and socioeconomic variables to assess the impact of the ACA.
“Graphically, we created trends for some of the outcomes of financial barriers measured by the National Health Interview Survey back to 1999, for a full span of 20 years to allow for visual comparison. This is the most extensive analysis done using the National Health Interview Survey to date,” Su said.
Results showed associations of ACA implementation with higher adjusted odds of Medicaid insurance (OR = 2.02; 95% CI, 1.72-2.36) and lower adjusted odds of no insurance (OR = 0.57; 95% CI, 0.48-0.68).
ACA implementation also appeared associated with lower adjusted odds of inability to afford medications (OR = 0.68; 95% CI, 0.59-0.79) or dental care (OR = 0.83; 95% CI, 0.73-0.94), as well as lower odds of delaying care (OR = 0.78; 95% CI, 0.69-0.89) among those aged 18 to 64 years.
Researchers additionally found that the ACA was associated with lower adjusted odds for secondary outcomes, including delaying refills for prescriptions, skipping doses of medication and anxiety about medical expenses. Conversely, similar associations were not observed among those aged older than 65 years.
“This analysis provides an important assessment of the impact that the ACA has had on cancer survivors aged younger than 65 years who are generally not eligible for Medicare ... [and] who required and often continue to require significant amounts of medical care during the survivorship period,” Su said. “With escalating financial costs associated with medical treatment and cancer care, updated studies focusing on patients who do not have the ‘Medicare social safety net’ are increasingly important because this population is likely the most vulnerable to financial stresses.”
The ACA may have reduced some measures of financial barriers tracked by the National Health Interview Survey to the lowest levels since 1999, he added.
ACA research will remain timely, as the historic legislation’s key provisions have only been implemented since 2014, according to Su.
“As of present, there continues to be legal challenges to dismantle both individual provisions and the entirety of the law. As such, timely and accurate scientific studies measuring the impact of the law must be conducted to better inform the public, the medical community and legislators,” Su said. “An area of great interest would be to assess, in a few more years, the impact that the repeal of the individual mandate in 2019 has on financial barriers experienced by cancer survivors.”
For more information:
Christopher T. Su, MD, MPH, can be reached at University of Michigan, 1500 E. Medical Center Drive, C369 Med Inn Building, SPC 5848, Ann Arbor, MI 48109; email: suchr@med.umich.edu.
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