TY - JOUR
T1 - Impacts of the Affordable Care Act Dependent Coverage Provision on Young Adults With Cancer
AU - Barnes, Justin M.
AU - Harris, Jenine K.
AU - Brown, Derek S.
AU - King, Allison
AU - Johnson, Kimberly J.
N1 - Funding Information:
Per the National Cancer Database data use agreement, it is acknowledged that the American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data. This work was supported by the Center for Health Economics and Policy Pilot Funding Program at the Institute for Public Health at Washington University (PI: Kimberly Johnson, MPH, PhD) and the Siteman Cancer Institute Leah Menshouse Summer Fellowship (Justin Barnes, MS). Justin Barnes conducted analyses, summarized results, and drafted and edited the manuscript. Jenine Harris contributed to overall study conception and design, analyses, and revisions of the manuscript. Derek Brown contributed to revisions of the manuscript. Allison King contributed to study conception and design and revisions of the manuscript. Kimberly Johnson supervised the project and contributed to analyses, results interpretation, drafting of the manuscript, and revisions.
Funding Information:
Per the National Cancer Database data use agreement, it is acknowledged that the American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data. This work was supported by the Center for Health Economics and Policy Pilot Funding Program at the Institute for Public Health at Washington University (PI: Kimberly Johnson, MPH, PhD) and the Siteman Cancer Institute Leah Menshouse Summer Fellowship (Justin Barnes, MS). Justin Barnes conducted analyses, summarized results, and drafted and edited the manuscript. Jenine Harris contributed to overall study conception and design, analyses, and revisions of the manuscript. Derek Brown contributed to revisions of the manuscript. Allison King contributed to study conception and design and revisions of the manuscript. Kimberly Johnson supervised the project and contributed to analyses, results interpretation, drafting of the manuscript, and revisions. No financial disclosures were reported by the authors of this paper.
Publisher Copyright:
© 2019 American Journal of Preventive Medicine
PY - 2019/5
Y1 - 2019/5
N2 - Introduction: Evidence through 2012 suggests that the 2010 Affordable Care Act Dependent Coverage Provision, extending dependent insurance coverage eligibility to age 26years, increased young adult insurance coverage and decreased cancer diagnosis stage in young adult cancer patients. This study examines Dependent Coverage Provision–associated changes in insurance coverage and diagnosis stage through 2014 in young adult cancer patients. Methods: Using a quasi-experimental study design, analyses were conducted in 2017–2018 using 2007 to 2014 data from the Surveillance, Epidemiology, and End Results (SEER) 18 and the National Cancer Database (NCDB). Using difference-in-differences analyses applied to linear probability models, changes in the percentage of policy-eligible individuals aged 19–25years versus ineligible individuals aged 27–29years who were insured (excluding Medicaid) and diagnosed at early (Stages 0 and 1) or late (Stage 4) stages following Dependent Coverage Provision enactment were estimated. Results: A total of 36,901 and 92,358 young adults were included from SEER and NCDB. Consistent increases in the percentage insured (SEER: 3.45 percentage points, 95% CI=2.04, 4.87; NCDB: 3.72 percentage points, 95% CI=2.80, 4.64); variable increases in early-stage diagnoses (2.25 percentage points, 95% CI=0.40, 4.10; 0.69 percentage points, 95% CI= –0.65, 2.02); and decreases in late-stage diagnoses (–1.74 percentage points, 95% CI= –3.10, –0.38; –0.58 percentage points, 95% CI= –1.46, 0.30) were observed in young adults aged 19–25 versus 27–29years. Conclusions: These results provide clear evidence for a Dependent Coverage Provision–associated impact on insurance coverage in young adult cancer patients; however, clear impacts on diagnosis stage are less evident.
AB - Introduction: Evidence through 2012 suggests that the 2010 Affordable Care Act Dependent Coverage Provision, extending dependent insurance coverage eligibility to age 26years, increased young adult insurance coverage and decreased cancer diagnosis stage in young adult cancer patients. This study examines Dependent Coverage Provision–associated changes in insurance coverage and diagnosis stage through 2014 in young adult cancer patients. Methods: Using a quasi-experimental study design, analyses were conducted in 2017–2018 using 2007 to 2014 data from the Surveillance, Epidemiology, and End Results (SEER) 18 and the National Cancer Database (NCDB). Using difference-in-differences analyses applied to linear probability models, changes in the percentage of policy-eligible individuals aged 19–25years versus ineligible individuals aged 27–29years who were insured (excluding Medicaid) and diagnosed at early (Stages 0 and 1) or late (Stage 4) stages following Dependent Coverage Provision enactment were estimated. Results: A total of 36,901 and 92,358 young adults were included from SEER and NCDB. Consistent increases in the percentage insured (SEER: 3.45 percentage points, 95% CI=2.04, 4.87; NCDB: 3.72 percentage points, 95% CI=2.80, 4.64); variable increases in early-stage diagnoses (2.25 percentage points, 95% CI=0.40, 4.10; 0.69 percentage points, 95% CI= –0.65, 2.02); and decreases in late-stage diagnoses (–1.74 percentage points, 95% CI= –3.10, –0.38; –0.58 percentage points, 95% CI= –1.46, 0.30) were observed in young adults aged 19–25 versus 27–29years. Conclusions: These results provide clear evidence for a Dependent Coverage Provision–associated impact on insurance coverage in young adult cancer patients; however, clear impacts on diagnosis stage are less evident.
UR - http://www.scopus.com/inward/record.url?scp=85062960984&partnerID=8YFLogxK
U2 - 10.1016/j.amepre.2018.12.011
DO - 10.1016/j.amepre.2018.12.011
M3 - Article
C2 - 30898535
AN - SCOPUS:85062960984
VL - 56
SP - 716
EP - 726
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
SN - 0749-3797
IS - 5
ER -