ArticleJournal of the National Cancer Institute2020
Changes in Noninsurance and Care Unaffordability Among Cancer Survivors Following the Affordable Care Act.
Article in Journal of the National Cancer Institute, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 1 of them a synthesis that pooled it.
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Who cites it
29 citing papers in PubMed, 1 synthesis or guideline pooled it, 52 citations in OpenAlex.
- The Affordable Care Act's Medicaid Expansion and Impact Along the Cancer-Care Continuum: A Systematic Review.Journal of the National Cancer Institute · 2020Pooled it
- Changes in Medicaid Enrollment Among Adult Survivors of Childhood Cancer After Medicaid Expansion: A Report From the Childhood Cancer Survivor Study.JCO oncology practice · 2026Article
- Disparities in overall survival and stage at presentation in oropharynx cancer across hispanic and latino populations in the United States.Oral oncology · 2025Article
- Cancer history and accelerated aging: findings from a nationally representative sample in the US.Cancer causes & control : CCC · 2025Article
- Association of Medicaid Expansion With Timely Receipt of Treatment and Survival Among Patients With HR-Negative, HER2-Positive Breast Cancer.Journal of the National Comprehensive Cancer Network : JNCCN · 2024Article
- Health insurance among survivors of childhood cancer following Affordable Care Act implementation.Journal of the National Cancer Institute · 2024Article
- Trends in cancer-related suicide in the United States: a population-based epidemiology study spanning 40 years of data.Translational psychiatry · 2024Article
- Inequity in Cancer and Cancer Care Delivery in the United States.Hematology/oncology clinics of North America · 2024Review
- Changes in cancer mortality after Medicaid expansion and the role of stage at diagnosis.Journal of the National Cancer Institute · 2023Article
- Transportation barriers, emergency room use, and mortality risk among US adults by cancer history.Journal of the National Cancer Institute · 2023Article
- High out‑of‑pocket spending and financial hardship at the end of life among cancer survivors and their families.Israel journal of health policy research · 2023Article
- The Affordable Care Act and suicide incidence among adults with cancer.Journal of cancer survivorship : research and practice · 2023Article
- Health behaviors, obesity, and marital status among cancer survivors: a MEPS study.Journal of cancer survivorship : research and practice · 2023Article
- Insurance Coverage and Forgoing Medical Appointments Because of Cost Among Cancer Survivors After 2016.JCO oncology practice · 2023Article
- Financial Hardship in Adult Survivors of Childhood Cancer in the Era After Implementation of the Affordable Care Act: A Report From the Childhood Cancer Survivor Study.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023Article
- Spatial-Temporal Trends in Ovarian Cancer Outcomes in California.JNCI cancer spectrum · 2022Article
- Did Medicaid expansion close African American-white health care disparities nationwide? A scoping review.BMC public health · 2022Article
- Association Between Medicaid Expansion Under the Affordable Care Act and Survival Among Newly Diagnosed Cancer Patients.Journal of the National Cancer Institute · 2022Article
- Policies and Practices to Address Cancer's Long-Term Adverse Consequences.Journal of the National Cancer Institute · 2022Article
- Cancer's Lasting Financial Burden: Evidence From a Longitudinal Assessment.Journal of the National Cancer Institute · 2022Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLittle is known about changes in socioeconomic disparities in noninsurance and care unaffordability among nonelderly cancer survivors following the Affordable Care Act (ACA).
methodsCancer survivors aged 18-64 years nationwide were identified from the Behavioral Risk Factor Surveillance System. Trend and difference-in-differences analyses were conducted to examine changes in percent uninsured and percent reporting care unaffordability pre-(2011 to 2013) and post-(2014 to 2017) ACA Medicaid expansion, by sociodemographic factors.
resultsA total of 118 631 cancer survivors were identified from Medicaid expansion (n = 72 124) and nonexpansion (n = 46 507) states. Following the ACA, percent uninsured and percent reporting care unaffordability decreased nationwide. Medicaid expansion was associated with a 1.8 (95% confidence interval [CI] = 0.1 to 3.5) percentage points (ppt) net decrease in noninsurance and a 2.9 (95% CI = 0.7 to 5.1) ppt net decrease in care unaffordability. In stratified analyses by sociodemographic factors, substantial decreases were observed in female survivors, those with low or medium household incomes, the unemployed, and survivors with multiple comorbidities. However, we observed slightly increased percentages in reporting noninsurance (ppt = 1.7; 95% CI = -1.2 to 4.5) and care unaffordability (ppt = 3.1, 95% CI = -0.4 to 6.5) in nonexpansion states between 2016 and 2017, translating to 67 163 and 124 160 survivors, respectively.
conclusionWe observed reductions in disparities by sociodemographic factors in noninsurance and care unaffordability among nonelderly cancer survivors following the ACA, with largest decreases in women, those with low or medium income, multiple comorbid conditions, the unemployed, and those residing in Medicaid expansion states. However, the uptick of 82 750 uninsured survivors in 2017, mainly from nonexpansion states, is concerning. Ongoing monitoring of the effects of the ACA is warranted, especially in evaluating health outcomes.
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