ACA linked to increase in cancer detection among adults younger than 65 years

The Affordable Care Act had a significant impact on cancer detection among adults nearing the age for Medicare enrollment, according to research published in Health Affairs.

“These results strongly suggest that continued improvements in health insurance coverage under the ACA would further reduce the remaining Medicare cancer detection discontinuity at age 65, thus improving the health outcomes of adults who were previously uninsured or underinsured,” Fabian Duarte, PhD, associate professor of economics at the University of Chile, and colleagues wrote.

Duarte and colleagues estimated the effects of increases in health insurance coverage from the 2014 ACA provisions on cancer detection. They used an empirical methodology with regression discontinuity and difference-in-differences research methods. The analysis included data from the 2010-2016 Surveillance, Epidemiology and End Results (SEER) program, which collected information on new cancer cases from about 37% of the U.S. population.

Duarte and colleagues observed a discontinuous decrease in rates of uninsured people aged younger than 65 years.

They determined that the rate of cancer detection increased by 75 cancers per 100,000 people among adults aged 55 to 64 years both before (2010-2013) and after (2014-2016) the ACA provisions were implemented.

Duarte and colleagues also determined that the cancer detection rate in both periods increased by 70 cancers per 100,000 people among adults aged 65 to 74 years.

From 2010 to 2013, the rate of cancer detection among those aged 64 to 65 years increased by 253 cancers per 100,000 people. From 2014 to 2016, after ACA provisions were implemented, the cancer detection rate among those 64 to 65 years decreased by 65 cancers per 100,000 people.

“The jump in cancer detection that occurs when people reach Medicare eligibility age was eliminated by the ACA coverage expansions,” the researchers wrote.

The difference-in-discontinuities regression model suggested that there was a decrease in Medicare discontinuity of 59 cancers per 100,000 people after the ACA was implemented.

When they used the Medicare cancer detection discontinuity before the ACA as a baseline — 132 cancers per 100,000 people — and adjusted for time and age, Duarte and colleagues found the implementation of the ACA reduced the Medicare cancer detection discontinuity by 45%.

The researchers also determined that the ACA led to a 43% reduction in breast, colorectal, prostate and cervical (BCPC) Medicare cancer detection discontinuity, and a 48% reduction in non-BCPC Medicare cancer detection discontinuity.

According to Duarte and colleagues, 68% of cancers that were detected were early or middle stage, which they said suggests that many of these cases were likely treatable and demonstrates benefit to patient survival.

“Our work highlights the important role of the ACA for the detection of cancers with and without routine screening tests,” Duarte and colleagues wrote. “A significant share of the newly detected cancers were identified at treatable stages, implying significant potential for health benefits.”