The number of insured patients with head and neck cancer (HNC) rose after the implementation of the Patient Protection and Affordable Care Act (ACA), according to the findings of a study published on October 31. The gains were the greatest for more vulnerable populations, including young people and those from low-income ZIP codes.
Previous research has linked the ACA to gains in insurance coverage among patients with other types of cancer, but fewer studies have focused on those with cancers of the head and neck region. The researchers used data from more than 100,000 patients with head and neck cancer to determine whether insurance coverage changed after implementation of the ACA. The findings are especially important because insurance coverage is tied to better health outcomes, the authors noted.
"Health insurance status is a major determinant of quality of care and outcomes for patients with cancer," wrote the authors, led by Neelima Panth, MD, MPH, from the Duke University School of Medicine in Durham, NC (JAMA Otolaryngology–Head & Neck Surgery, October 31, 2019). "The objective of this study was to examine the association between implementation of the ACA and insurance status across socioeconomic and demographic subpopulations of patients with HNC."
For their study, the researchers included data from 131,779 adult patients in the National Cancer Database, a hospital-based database that contains the majority of new cancer diagnoses in the U.S. The patients were diagnosed with head and neck cancer between 2011 and 2015, and the researchers analyzed the difference in insurance coverage before and after the main provisions of the ACA were implemented on January 1, 2014.
The ACA was significantly associated with a drop in the number of patients without insurance, the researchers found. The percentage of patients without insurance decreased from 7.7% before the ACA to 4.9% after the law went into effect.
"The period after implementation of the ACA was associated with a decrease in [the] percentage of uninsured patients with HNC overall," the authors wrote. "Prior studies show that this trend is consistent with that seen both in the overall cancer population as well as in other types of cancer, suggesting an increase in access to health services for many patients with cancer nationwide."
Younger patients, defined as those between the ages of 18 and 34, had one of the largest jumps in insurance coverage. Patients from low-income ZIP codes also were significantly less likely to be uninsured after ACA implementation.
"Overall, this study demonstrates that the ACA was effective in increasing insurance coverage for populations of patients with HNC with historically limited access to care, including low-income groups and younger adults with HNC," the authors wrote.
While the study included a large number of patients, it also had several shortcomings, the researchers noted. Notably, the data used did not include information on the quality of patients' healthcare or whether patients kept their health insurance long term. Nevertheless, the authors believe their findings demonstrate the ACA successfully increased insurance rates for patients with head and neck cancer.
"Our study suggests that the ACA was successful in increasing coverage among patients with HNC, a subgroup of patients with cancer whose disease treatment can be particularly complex and costly," they concluded. "Future studies should investigate the association of the ACA with access to evidence-based treatment of HNC, particularly in vulnerable patient populations."