The Impact of the Affordable Care Act on Disparities in Private and Medicaid Insurance Coverage Among Patients Under 65 With Newly Diagnosed Cancer.
Int J Radiat Oncol Biol Phys
; 105(1): 25-30, 2019 09 01.
Article
en En
| MEDLINE
| ID: mdl-31150741
PURPOSE: To investigate the impact of the Affordable Care Act on racial and rural-urban disparities in insurance coverage for patients under age 65 with cancer. METHODS AND MATERIALS: Using the Surveillance, Epidemiology, and End Results data from 2011 to 2015, we calculated the proportions of uninsured, Medicaid, and non-Medicaid insured (including private insurance) patients before and after the Medicaid expansion. We calculated the absolute percent change and difference in differences (DiD) to evaluate whether the Medicaid expansion had an impact on the distribution of types of insurance. Adjusted DiD analyses accounted for age, race, sex, county-level median household income, and rural-urban residence. RESULTS: There was a greater decrease in uninsured rate in expansion states (-3.0%) versus nonexpansion states (-0.9%, DiD -2.1%), particularly among Black (DiD -3.4%), Hispanic (-3.9%), and rural patients (-4.8%). In expansion states, an increase in the proportion of patients with Medicaid coincided with a decrease in the proportion with non-Medicaid insurance; the opposite was observed in nonexpansion states. The decrease in non-Medicaid insurance varied by patient race: Asian/Pacific Islanders (adjusted DiD -9.7%), Hispanic (-4.2%), non-Hispanic black (-4.0%), and non-Hispanic white (-2.8%). CONCLUSIONS: Medicaid expansion versus nonexpansion states observed a slightly greater reduction in the uninsured rate, but Medicaid expansion states also observed a corresponding shift from non-Medicaid (including private) to Medicaid insurance, which may paradoxically exacerbate disparities in access to care and cancer outcomes. Long-term outcomes and continued study are required to fully understand the impact of the Affordable Care Act on disparities in cancer care.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Medicaid
/
Pacientes no Asegurados
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Cobertura del Seguro
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Disparidades en Atención de Salud
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Patient Protection and Affordable Care Act
/
Neoplasias
Tipo de estudio:
Diagnostic_studies
/
Prognostic_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Adolescent
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Adult
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Child
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Child, preschool
/
Female
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Humans
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Infant
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Male
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Middle aged
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Newborn
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Int J Radiat Oncol Biol Phys
Año:
2019
Tipo del documento:
Article
Pais de publicación:
Estados Unidos