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Health insurance among survivors of childhood cancer following Affordable Care Act implementation.
Kirchhoff, Anne C; Waters, Austin R; Liu, Qi; Ji, Xu; Yasui, Yutaka; Yabroff, K Robin; Conti, Rena M; Huang, I-Chan; Henderson, Tara; Leisenring, Wendy M; Armstrong, Gregory T; Nathan, Paul C; Park, Elyse R.
Afiliação
  • Kirchhoff AC; Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
  • Waters AR; Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA.
  • Liu Q; Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA.
  • Ji X; Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA.
  • Yasui Y; Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada.
  • Yabroff KR; Department of Pediatrics, Emory University School of Medicine/AFLAC Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
  • Conti RM; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
  • Huang IC; Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
  • Henderson T; Department of Markets, Public Policy, and Law, Boston University Questrom School of Business, Boston, MA, USA.
  • Leisenring WM; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
  • Armstrong GT; Department of Pediatrics, University of Chicago, Comer Children's Hospital, Chicago, IL, USA.
  • Nathan PC; Clinical Research and Public Health Science Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA.
  • Park ER; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
J Natl Cancer Inst ; 116(9): 1466-1478, 2024 Sep 01.
Article em En | MEDLINE | ID: mdl-38741226
ABSTRACT

BACKGROUND:

The Affordable Care Act (ACA) increased private nonemployer health insurance options, expanded Medicaid eligibility, and provided preexisting health condition protections. We evaluated insurance coverage among long-term adult survivors of childhood cancer pre- and post-ACA implementation.

METHODS:

Using the multicenter Childhood Cancer Survivor Study, we included participants from 2 cross-sectional surveys pre-ACA (2007-2009; survivors n = 7505; siblings n = 2175) and post-ACA (2017-2019; survivors n = 4030; siblings n = 987). A subset completed both surveys (1840 survivors; 646 siblings). Multivariable regression models compared post-ACA insurance coverage and type (private, public, uninsured) between survivors and siblings and identified associated demographic and clinical factors. Multinomial models compared gaining and losing insurance vs staying the same among survivors and siblings who participated in both surveys.

RESULTS:

The proportion with insurance was higher post-ACA (survivors pre-ACA 89.1% to post-ACA 92.0% [+2.9%]; siblings pre-ACA 90.9% to post-ACA 95.3% [+4.4%]). Post-ACA insurance increase in coverage was higher among those aged 18-25 years (survivors +15.8% vs +2.3% or less ages 26 years and older; siblings +17.8% vs +4.2% or less ages 26 years and older). Survivors were more likely to have public insurance than siblings post-ACA (18.4% vs 6.9%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.1 to 2.6). Survivors with severe chronic conditions (OR = 4.7, 95% CI = 3.0 to 7.3) and those living in Medicaid expansion states (OR = 2.4, 95% CI = 1.7 to 3.4) had increased odds of public insurance coverage post-ACA. Among the subset completing both surveys, low- and mid-income survivors (<$40 000 and <$60 000, respectively) experienced insurance losses and gains in reference to highest household income survivors (≥$100 000), relative to odds of keeping the same insurance status.

CONCLUSIONS:

Post-ACA, more childhood cancer survivors and siblings had health insurance, although disparities remain in coverage.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cobertura do Seguro / Patient Protection and Affordable Care Act / Sobreviventes de Câncer / Seguro Saúde / Neoplasias Limite: Adolescent / Adult / Child / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: J Natl Cancer Inst Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Cobertura do Seguro / Patient Protection and Affordable Care Act / Sobreviventes de Câncer / Seguro Saúde / Neoplasias Limite: Adolescent / Adult / Child / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: J Natl Cancer Inst Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: Estados Unidos