Health Services Research

SS 11 - HSR 1

80 - Impact of Dependent Coverage Provision and Medicaid Expansion on Disparities in Insurance Coverage Among Young Cancer Patients

Monday, October 22
8:15 AM - 8:25 AM
Location: Room 007 A/B

Impact of Dependent Coverage Provision and Medicaid Expansion on Disparities in Insurance Coverage Among Young Cancer Patients
A. Agarwal1, A. E. Katz2, and R. C. Chen3; 1University of North Carolina - Chapel Hill, Chapel Hill, NC, 2University of North Carolina Chapel Hill, Chapel Hill, NC, 3University of North Carolina Hospitals, Chapel Hill, NC

Purpose/Objective(s): The dependent coverage provision (DCP) of the Affordable Care Act (ACA) went into effect in September 2010. Insurers were required to allow children up to age 26 to remain on their parents’ private health insurance plans. The Medicaid expansion started in 2014. We examined the impact of DCP and Medicaid expansion on racial disparities in insurance coverage for cancer patients age 19-25.

Materials/Methods: Young cancer patients were identified using the SEER 18 registry. We compared insurance rates by race (Black vs. White) and median family income by county (low income ≤ $55,000, high Income >$55,000). Analysis was stratified by patients aged 19-25 (affected by DCP) and patients aged 26-31 (control group, not affected by DCP). We analyzed insurance rates of these young cancer patients in 2008-10 (pre DCP), 2011-13 (post DCP), and 2014 (Medicaid expansion). Differences among groups were assessed using the Chi-square test.

Results: Among patients age 19-25, uninsured rates decreased from 2008-10 to 2011-13 for White patients and those who lived in high income counties (Table); however, uninsured rates did not change significantly for Black patients and those who lived in low income counties. In contrast, among patients age 26-31, uninsured rates increased from 2008-10 to 2011-13. After the Medicaid expansion (2014), uninsured rates decreased nearly all subgroups of patients 19-25 and 26-31.

Conclusion: The impact of the dependent coverage provision of the ACA on reducing uninsured rates among young cancer patients across the US was mainly in White patients and those who lived in high income counties, and appeared to increase disparities. On the other hand, Medicaid expansion reduced uninsured rates across almost all groups. The differential impact of these two policies has important implications for the availability of timely cancer care and reducing disparities in insurance coverage among young patients with cancer. Table 1: Uninsured Rates before and after the DCP and after the Medicaid Expansion (2014)
Uninsured Rate for Patients aged 19-25 Uninsured Rate for Patients aged 26-31 (Control Group)
2008-10 2011-13 p value 2014 p-value 2008-10 2011-13 p-value 2014 (p-value)
Overall 9.9% 8.0% <0.01 4.9% <0.01 8.0% 8.5% 0.10 5.6% (<0.01)
White 9.8% 7.5% <0.01 4.3% <0.01 7.9% 8.5% 0.09 5.3% (<0.01)
Black 13.4% 15.6% 0.22 11.0% 0.08 11.8% 12.8% 0.45 10.0% (0.08)
High Income Counties 9.5% 7.5% <0.01 4.7% <0.01 7.6% 7.9% 0.43 5.1% (<0.01)
Low Income Counties 12.2% 10.8% 0.27 6.2% <0.01 9.9% 11.8% 0.03 8.3% (<0.01)

Author Disclosure: A. Agarwal: None. A.E. Katz: None. R.C. Chen: Research Grant; Accuray Inc. Consultant; Accuray Inc.

Ankit Agarwal, MD, MBA

Disclosure:
Employment
UNC Chapel Hill: Resident Physician: Employee

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