Disparities in health care affordability among childhood cancer survivors persist following the Affordable Care Act

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Background: The Affordable Care Act (ACA) included many provisions that may have improved access to care for childhood cancer survivors (CCS). In this study, we sought to compare health insurance coverage and the affordability of health care among adult childhood CCS before and after the implementation of the ACA. Procedure: Using data from the National Health Interview Survey (NHIS), two cohorts of CCS age 21–65 years old and matched (1:3) controls without a history of cancer were identified. A difference-in-differences analysis was used to compare insurance coverage and health care affordability pre- (2011–2013) and post-ACA (2015–2017). Results: There were 309 CCS identified in the pre-ACA cohort and 324 in the post-ACA cohort. The two cohorts were similar in demographic composition. Prior to the ACA, CCS were 39% more likely to be uninsured than their peers (p =.046). Post, there was no difference in the odds of being uninsured between CCS and their peers. Following implementation of the ACA, the proportion of CCS who reported having difficulty with the affordability of health care decreased (p =.013) as did the proportion reporting skipping needed care due to cost (p <.001). However, 13% of CCS still reported being uninsured, 36% reported difficulty paying for health care, and 13% reported foregoing needed care due to cost. Relative to their peers, CCS saw improvement in foregoing needed care due to cost, but disparities still remain. Conclusions: Although improvements were observed, health care affordability, and medical nonadherence remains a problem for CCS. Implications for cancer survivors: Additional efforts are needed to improve health care affordability among CCS.

Original languageEnglish
Article numbere29370
JournalPediatric Blood and Cancer
Issue number12
StatePublished - Dec 2021


  • adherence
  • childhood cancer survivors
  • financial toxicity
  • health care affordability


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