ACA Linked With Small Improvements in Out-of-Pocket Costs for Patients With Cancer

The Patient Protection and Affordable Care Act (ACA) was associated with small improvements in insurance continuity and out-of-pocket expenditures for nonelderly patients with cancer, but large financial burdens remained, according to a new study published online in JAMA Network Open.

“Nonelderly patients with cancer in the United States continue to cope with a complex insurance marketplace and high risks of catastrophic health expenditures, despite the well-intentioned policy reforms of the ACA,” researchers wrote. “In particular, low-income patients with cancer with private insurance coverage may face lower risks of periods of uninsurance, but underinsurance is associated with high risks of catastrophic health expenditures.”

The study used data from the Medical Expenditure Panel Survey from 2005 to 2018 to assess whether the ACA was associated with lower risks of insurance churn (defined as a gain, loss, or change in coverage) and catastrophic health expenditures. Because the ACA aimed to reduce financial burden, particularly among patients with preexisting conditions, the study focused on nonelderly patients with cancer.

In any year during the study period, patients with cancer were at overall lower risk of insurance churn compared with people without cancer, researchers reported. Yet despite higher rates of insurance coverage, patients with cancer faced much higher risks of catastrophic health expenditures, most likely due to higher use of health care.

Full ACA implementation was associated with a 4% reduction in the annual risk of uninsurance in patients with cancer, according to the study. The ACA was also linked with a 3% lower risk of catastrophic spending in the patient population—but only when insurance premiums were excluded.

“Oncologists should be cognizant of the financial strains that cancer places on patients and families, even when insured,” researchers advised. “Further health reforms to cover the remaining uninsured individuals and to increase plan generosity are needed to adequately protect the population of individuals with cancer, which already faces significant physical and mental burden from disease.”

Reference:
Albright BB, Chino F, Chino JP, Havrilesky LJ, Aviki EM, Moss HA. Associations of Insurance Churn and Catastrophic Health Expenditures With Implementation of the Affordable Care Act Among Nonelderly Patients With Cancer in the United States. JAMA Netw Open. 2021;4(9):e2124280. Published 2021 Sep 1. doi:10.1001/jamanetworkopen.2021.24280