Dip in cancer-related deaths among younger adults linked to ACA’s dependent coverage

Key takeaways:

• Both cancer survival and mortality improved among those aged 19 to 25 years vs. those aged younger or older.
• Other diseases may have similar better outcomes following the ACA enactment, a researcher said.

Young adults with cancer who were eligible for the Affordable Care Act’s dependent care expansion had greatly improved survival times during the first decade of the ACA, an analysis in Cancer showed.

“The trends indicate that the cancer survival and mortality trends will continue to improve, as long as we have the ACA,” Michael Roth, MD, from The University of Texas MD Anderson Cancer Center, told Healio. “They support expanding the [dependent care expansion] and having more states utilize the Medicaid provision of the ACA. Moreover, they suggest that other diseases, injuries, mental health disorders, and general health issues are also benefiting the age group eligible for the ACA [dependent care expansion], and not just cancer.”

According to Roth and colleagues, the ACA, passed in 2010, included a dependent care expansion provision that allowed young adults aged 19 to 25 years to remain on their parents’ health insurance plans until age 26 years.

Those aged 19 to 25 years had the highest uninsured rates of any age group before 2011, the researchers noted, while uninsured adolescents and young adults have longer lag times from initial symptoms to diagnosis and worse long-term survival vs. their insured peers.

Roth and colleagues analyzed cancer survival and mortality trends before and after ACA enactment among those aged 19 to 25 years and compared them with changes in a younger control group (those aged 12 to 18 years) and an older control group (those aged 26 to 32 years).

The researchers used CDC data on cancer deaths for the analysis, while cancer survival data came from the National Cancer Institute Surveillance, Epidemiology, and End Results database.

The researchers found that the cohort eligible for dependent care expansion coverage was the only age group of the three that experienced improvements in both cancer survival and death rate trends after the ACA’s passing.

They also noted 2010 as the inflection year for both survival and deaths in the age group eligible for dependent care expansion coverage.

Roth and colleagues pointed out the expansion group had a significantly higher 3-year relative survival rate than previously reported.

They reported a relative survival rate 6 years after ACA enactment for the expansion group 2.6 times greater vs. the young control group and 3.9 times greater vs. the older control group.

The cancer death rate in the expansion‐eligible age group further improved 2.1 and 1.5 times greater than in the younger and older control groups, respectively, within 12 years after the ACA’s passing.

The benefits seen for young adults will ultimately occur in older adults, “including earlier diagnoses, more favorable disease stage, longer survival durations and higher cure rates,” Roth and colleagues wrote.

They also acknowledged some study limitations. For example, the analysis did not include factors like race and ethnicity, the cancers that most benefited or the adverse effects of cancer diagnoses and treatments.

The study also did not consider the impact of socioeconomic status and Medicaid expansion states.

“Primary care providers can now diagnose young adults on the ACA [dependent care expansion] more adequately than they could before the ACA,” Roth told Healio. “They can diagnose cancer earlier and enable less therapy for more favorable stages of cancer, as well as better survival and higher cure rates. And they should defend the ACA and support its expansion.”

Roth added the findings also highlight “the urgent need to further decrease the rate of uninsured adolescents and young adults in the United States, let alone older age groups, and decrease time to diagnosis and require treatment intensity, along with prioritizing research in general regarding access to health care and cancer care delivery.”

References:

• Has the Affordable Care Act’s Dependent Coverage Expansion benefited young adults diagnosed with cancer? Available at: https://newsroom.wiley.com/press-releases/press-release-details/2024/Has-the-Affordable-Care-Acts-Dependent-Coverage-Expansion-benefited-young-adults-diagnosed-with-cancer/default.aspx. Published Oct. 7, 2024. Accessed Oct. 7, 2024.
• Roth M, et al. Cancer. 2024;doi:10.1002/cncr.35538.