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- W2895811325 abstract "To evaluate trends of historic sociodemographic disparities in insurance coverage and cancer treatment patterns in non-elderly adults with a common cancer after Affordable Care Act (ACA) implementation based on state approach to Medicaid expansion. A national cohort of 109,182 patients ages 18-64 diagnosed with a common cancer (lung, breast, or prostate cancer) was identified from 2010-2014. Multivariable logistic regressions analyzed associations between ACA implementation and cancer outcomes based on state approach to Medicaid expansion, stratified by race (black, white) and income (stratified at 138% federal poverty line [FPL]). Interaction terms were applied as appropriate. Both uninsured rates and cancer treatment rates declined after ACA implementation, with the greatest rate reductions associated with Medicaid expansion (pinteraction<0.001 and pinteraction=0.024, respectively). Racial disparities in insurance coverage were eliminated with Medicaid expansion where the uninsured rate went from 10.0% to 0.95% among black patients (AORpre-aca1.52 to AORpost-aca0.47), but persisted with other state approaches (AORpre-aca 1.15 to AORpost-aca1.12) [pinteraction=0.002]. However, racial disparities in cancer treatment did not change by state approach to Medicaid (pinteraction=0.516). Furthermore, socioeconomic coverage gaps were eliminated with Medicaid expansion, where the uninsured rate went from 8.4% to 1.4% among low-income (≤138% FPL) patients, but not with other state approaches [pinteraction<0.001]. Nevertheless, Medicaid expansion was associated with greater cancer treatment gaps between low and higher income patients (AORpre-aca0.85 to AORaca0.72) versus other state options (AORpre-aca1.07 to AORaca1.48) [pinteraction<0.001]. Medicaid expansion was associated with the elimination of racial and socioeconomic insurance coverage gaps, but also with persistent and potentially widened treatment gaps. These results highlight the potential benefits and challenges of the ACA and its provisions, and could instruct ongoing policy." @default.
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- W2895811325 date "2018-11-01" @default.
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- W2895811325 title "Early Impact of the Affordable Care Act and Medicaid Expansion on Racial and Socioeconomic Disparities in Cancer Care" @default.
- W2895811325 doi "https://doi.org/10.1016/j.ijrobp.2018.07.1225" @default.
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