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Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act.

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Chino, F; Suneja, G; Moss, H; Zafar, SY; Havrilesky, L; Chino, J
Published in: Int J Radiat Oncol Biol Phys
May 1, 2018

PURPOSE: To compare insurance status in cancer patients receiving radiation before and after Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), in both expanded and non-expanded states. METHODS AND MATERIALS: Newly diagnosed cancer patients aged 18 to 64 years who received radiation from 2011 to 2014 were compiled from the Surveillance, Epidemiology, and End Results database. Patients with a prior cancer diagnosis or unknown insurance status were excluded. Insurance rates at diagnosis were examined before (2011-2013) and after Medicaid expansion (2014) and compared between states that fully or did not fully expand Medicaid. RESULTS: A total of 197,290 patients were analyzed. Of these, 73% lived in expanded states. After expansion, there was a 53% relative decrease in uninsured rates in expanded states (4.3%-2.1%) and a 5% relative decrease in non-expanded states (8.4%-8.0%) (P < .0001). In expanded states, the uninsured rate decreased regardless of race (whites: relative decrease 56%, 4.3% to 1.9%; blacks: relative decrease 50%, 6.0 to 3.0%; both P < .0001) or county poverty level (low poverty: relative decrease 46%, 3.9% to 2.1%; high poverty: relative decrease 60%, 4.5% to 1.8%; both P < .0001). In non-expanded states, a decrease in uninsured levels was seen primarily in whites (relative decrease 9%, 7.8% to 7.1%, P < .0001; blacks: relative increase 7%, 9.9% to 10.6%, P = .37) and those living in areas with the lowest poverty (relative decrease 27%, 4.8% to 3.5%, P = .04; high poverty: relative increase 2%, 10.9% to 11.1%, P = .17). Blacks and those living in the highest poverty areas had the greatest level of benefit from full expansion (absolute benefit 2.0%-2.3%, P = .0093 and P = .0029, respectively). CONCLUSIONS: Medicaid expansion in 2014 significantly decreased uninsured rates for cancer patients receiving radiation. Full expansion decreased rates of uninsurance to a greater degree and seemed to decrease racial and economic disparities.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2018

Volume

101

Issue

1

Start / End Page

9 / 20

Location

United States

Related Subject Headings

  • White People
  • United States
  • SEER Program
  • Retrospective Studies
  • Poverty Areas
  • Patient Protection and Affordable Care Act
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Medically Uninsured
 

Citation

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Chino, F., Suneja, G., Moss, H., Zafar, S. Y., Havrilesky, L., & Chino, J. (2018). Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act. In Int J Radiat Oncol Biol Phys (Vol. 101, pp. 9–20). United States. https://doi.org/10.1016/j.ijrobp.2017.12.006
Chino, Fumiko, Gita Suneja, Haley Moss, S Yousuf Zafar, Laura Havrilesky, and Junzo Chino. “Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act.” In Int J Radiat Oncol Biol Phys, 101:9–20, 2018. https://doi.org/10.1016/j.ijrobp.2017.12.006.
Chino F, Suneja G, Moss H, Zafar SY, Havrilesky L, Chino J. Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act. In: Int J Radiat Oncol Biol Phys. 2018. p. 9–20.
Chino, Fumiko, et al. “Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act.Int J Radiat Oncol Biol Phys, vol. 101, no. 1, 2018, pp. 9–20. Pubmed, doi:10.1016/j.ijrobp.2017.12.006.
Chino F, Suneja G, Moss H, Zafar SY, Havrilesky L, Chino J. Health Care Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status After Medicaid Expansion Under the Affordable Care Act. Int J Radiat Oncol Biol Phys. 2018. p. 9–20.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2018

Volume

101

Issue

1

Start / End Page

9 / 20

Location

United States

Related Subject Headings

  • White People
  • United States
  • SEER Program
  • Retrospective Studies
  • Poverty Areas
  • Patient Protection and Affordable Care Act
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Medically Uninsured