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. 2020 Jul;7(4):252-258.
doi: 10.1097/upj.0000000000000109. Epub 2020 Jul 1.

The Association Between the Affordable Care Act and Insurance Status, Stage and Treatment in Patients with Testicular Cancer

Walter Hsiang  1 , Xuesong Han  2 , Ahmedin Jemal  2 , Kevin A Nguyen  3 , Brian Shuch  4 , Henry Park  5   6 , James B Yu  5   6 , Cary P Gross  6   7 , Amy J Davidoff  6   8 , Michael S Leapman  6   9
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The Association Between the Affordable Care Act and Insurance Status, Stage and Treatment in Patients with Testicular Cancer

Walter Hsiang et al. Urol Pract. 2020 Jul.

Abstract

Purpose: We aimed to determine whether insurance expansions implemented through the Affordable Care Act (ACA) were associated with changes in coverage status, disease stage, and treatment of younger adults with testicular germ cell tumors (GCT).

Materials and methods: We identified men aged 18-64 diagnosed with testicular GCTs between 2010 and 2015 in the National Cancer Data Base. We defined time periods as: pre-ACA (2010-2013) and post-ACA (2014-2015) and used difference-in-differences (DID) modeling to examine associations between state Medicaid expansion status and changes in insurance, stage at diagnosis, and treatment.

Results: Following the ACA, the proportion of patients with any health insurance increased 3.7% (95% CI 3-4.5) in Medicaid expansion states and 3.0% (95% CI 1.5-4.5) in non-expansion states, mainly by gaining Medicaid and private insurance, respectively. The largest increases occurred in low-income patients, where Medicaid expansion was associated with an adjusted increase of 14.5 percentage points (95% CI 7.2-21.8) in Medicaid coverage following the ACA. We did not observe reductions in late-stage diagnoses during the observation period. Changes in the proportion of patients receiving chemotherapy or radiation for advanced-stage cancers were ongoing prior to the ACA and differed between expansion and non-expansion states, limiting assessment of ACA-related effects on individual treatments.

Conclusions: Post-ACA, the proportion of newly diagnosed testicular cancer patients with health insurance increased, with the largest effects seen among lowest income individuals. Our findings that changes in practice preceded the ACA and differed by expansion status highlight the need for caution in assessing the legislation's impact.

Keywords: Affordable Care Act; Medicaid Expansion; Testicular Cancer; Uninsurance.

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Figures

Figure 1:
Figure 1:
Sample selection inclusion and exclusion criteria
Figure 2:
Figure 2:
Trends in quarterly insurance status among patients with newly diagnosed testicular cancer age 18–64 years by (A) uninsured, (B) Medicaid insurance, and (C) privately insured. †p values represent pre- vs post-ACA differences
See this image and copyright information in PMC

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References

    1. Smith JCM, Carla. Health Insurance Coverage in the United States: 2014: United States Census Bureau; 2015.
    1. Wherry LR, Miller S. Early Coverage, Access, Utilization, and Health Effects of the Affordable Care Act Medicaid Expansions: A Quasi-Experimental Study. Annals of internal medicine. 2016;164:795–803. - PMC - PubMed
    1. Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-reported insurance coverage, access to care, and health under the affordable care act. JAMA. 2015;314:366–374. - PubMed
    1. Bleyer WA. Potential Favorable Impact of the Affordable Care Act of 2010 on Cancer in Young Adults in the United States. The Cancer Journal. 2010;16:563–571. - PubMed
    1. Kirchhoff AC, Lyles CR, Fluchel M, Wright J, Leisenring W. Limitations in health care access and utilization among long-term survivors of adolescent and young adult cancer. Cancer. 2012;118:5964–5972. - PubMed