The Affordable Care Act improved health insurance coverage and cardiovascular-related screening rates for cancer survivors seen in community health centers

Heather E Angier, Miguel Marino, Rachel J Springer, Teresa D Schmidt, Nathalie Huguet, Jennifer E DeVoe, Heather E Angier, Miguel Marino, Rachel J Springer, Teresa D Schmidt, Nathalie Huguet, Jennifer E DeVoe

Abstract

Background: This study assessed the impact of Affordable Care Act (ACA) Medicaid expansion on health insurance rates and receipt of cardiovascular-related preventive screenings (body mass index, glycated hemoglobin [HbA1c], low-density lipoproteins, and blood pressure) for cancer survivors seen in community health centers (CHCs).

Methods: This study identified cancer survivors aged 19 to 64 years with at least 3 CHC visits in 13 states from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). Via inverse probability of treatment weighting multilevel multinomial modeling, insurance rates before and after the ACA were estimated by whether a patient lived in a state that expanded Medicaid, and changes between a pre-ACA time period and 2 post-ACA time periods were assessed.

Results: The weighted estimated sample size included 409 cancer survivors in nonexpansion states and 2650 in expansion states. In expansion states, the proportion of uninsured cancer survivors decreased significantly from 20.3% in 2012-2013 to 4.5%in 2016-2017, and the proportion of those with Medicaid coverage increased significantly from 38.8% to 55.6%. In nonexpansion states, there was a small decrease in uninsurance rates (from 33.6% in 2012-2013 to 22.5% in 2016-2017). Cardiovascular-related preventive screening rates increased over time in both expansion and nonexpansion states: HbA1c rates nearly doubled from the pre-ACA period (2012-2013) to the post-ACA period (2016-2017) in expansion states (from 7.2% to 12.8%) and nonexpansion states (from 9.3% to 16.8%).

Conclusions: This study found a substantial decline in uninsured visits among cancer survivors in Medicaid expansion states. Yet, 1 in 5 cancer survivors living in a state that did not expand Medicaid remained uninsured. Several ACA provisions likely worked together to increase cardiovascular-related preventive screening rates for cancer survivors seen in CHCs.

Keywords: Affordable Care Act; cancer survivors; community health centers; health insurance.

Conflict of interest statement

The authors made no disclosures.

© 2020 Oregon Health & Science University. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

Figures

Figure 1
Figure 1
Adjusted likelihood of being uninsured, insured/uninsured, insured with Medicaid, or insured with some private insurance during each 2‐year period (2012‐2013, 2014‐2015, and 2016‐2017) by expansion status. We estimated parameter coefficients and their associated standard errors by using generalized structural equation modeling and incorporating patient random effects to account for repeated observations within a patient over time; we then used the estimated regression coefficients to obtain adjusted predicted probabilities of each insurance category and report those over time for each expansion group. ACA indicates Affordable Care Act Medicaid expansion.

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Source: PubMed

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