Childhood Cancer Survivor Study participants' perceptions and understanding of the Affordable Care Act

Abstract

Purpose: The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown.

Methods: Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study.

Results: Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered "very important" are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as "very important" (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees.

Conclusion: Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits.

Fig 1.

CONSORT diagram.

Fig 2.

Familiarity of (A) survivors of childhood cancer and their siblings and of (B) insured and uninsured survivors with health insurance–related legislation. Multivariable logistic regressions adjusted for current age, sex, marital status, and chronic disease. Models comparing survivors and siblings were also adjusted for insurance status. ACA, Patient Protection and Affordable Care Act; ADA, Americans with Disabilities Act; COBRA, Consolidated Omnibus Budget Reconciliation Act; FMLA, Family Medical Leave Act; HIPAA, Health Insurance Portability and Accountability Act; OR, odds ratio.