Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_36_2954 - The Impact of the Affordable Care Act on the Uninsured Rate and Cancer Treatment in HIV-Infected Cancer Patients in the U.S.

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

The Impact of the Affordable Care Act on the Uninsured Rate and Cancer Treatment in HIV-Infected Cancer Patients in the U.S.
K. L. Corrigan1, C. C. Lin2, X. Han3, J. P. Chino4, A. Coghill5, M. Shiels5, A. Jemal3, and G. Suneja6; 1Duke University School of Medicine, Durham, NC, 2American Cancer Society, Atlanta, GA, 3American Cancer Society, Inc., Atlanta, GA, 4Duke University Medical Center, Durham, NC, 5National Cancer Institute, Rockville, MD, 6Department of Radiation Oncology, Duke University School of Medicine, Durham, NC

Purpose/Objective(s): The implementation of the Affordable Care Act (ACA) increased insurance rates and improved care access among cancer patients in the U.S. The expansion of Medicaid improved insurance availability for HIV patients; however, little is known about the impact on people living with HIV and cancer (PLWHC). We hypothesized that insurance coverage improvements would mitigate documented cancer care disparities among PLWHC. To investigate this, we examined the impact of the ACA on the uninsured rate, cancer stage and cancer treatment receipt among PLWHC.

Materials/Methods: HIV-infected patients aged 18-64 with cancers of the head and neck, upper GI tract, colorectum, anus, lung, female breast, cervix, prostate, Hodgkin lymphoma and diffuse large B-cell lymphoma diagnosed between Q1 of 2010 and Q4 of 2014 were identified in the National Cancer Database. Clinical and demographic covariates were analyzed. Insurance rates at diagnosis were compared pre-ACA (Q1 2010 to Q3 2013) and post-ACA (Q1 2014 to Q4 2014) in both Medicaid expansion and non-expansion states. Cancer treatment was defined as surgery, chemotherapy and/or radiotherapy. The proportion of PLWHC receiving cancer treatment pre- and post-ACA was tabulated. Chi-square testing was used to compare clinical and demographic variables among PLWHC in the pre-ACA and post-ACA eras, as well as in Medicaid-expansion vs. non-expansion states.

Results: 5,856 PLWHC were analyzed; 4,440 were diagnosed with cancer in the pre-ACA era and 1,416 in the post-ACA era. 50% of PLWHC lived in states with Medicaid expansion. Median age was 48 years, with the majority being men of black race or Hispanic ethnicity. PLWHC living in Medicaid-expansion states were more often white race and higher income compared with non-expansion states. The total uninsured rate among PLWHC decreased from 12% in the pre-ACA era to 10% in the post-ACA era. The proportion of HIV-infected patients who received cancer treatment increased from 84% to 87%. Cancer stage did not differ between the pre and post-ACA era. More PLWHC received cancer treatment in academic research programs in the post-ACA era (44%, p=0.003) and in Medicaid-expansion states (44%, p<0.0001). In expansion states, 6% of HIV-infected patients were uninsured at the time of their cancer diagnosis compared with 18% in states without expansion (p<0.01). In expansion states, there was a 4% increase in the proportion of PLWHC receiving cancer treatment compared to no change in non-expansion states.

Conclusion: The implementation of the ACA improved insurance rates and cancer treatment rates among PLWHC. Those with demographic risk factors for not receiving cancer treatment (black race and low income) more often lived in non-expansion states. This study identifies the need for further insurance expansion to ensure access to cancer treatment for PLWHC.

Author Disclosure: K.L. Corrigan: None. C. Lin: None. J.P. Chino: Partner; Duke University Cancer Center. Stock; NanoScint. Co-Founder/Owner; NanoScint. A. Coghill: None. M. Shiels: None. A. Jemal: None.

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