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

Abstract

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. 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. 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. 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.Abstract 80; Table 1Uninsured Rates before and after the DCP and after the Medicaid Expansion (2014)Uninsured Rate for Patients aged 19-25Uninsured Rate for Patients aged 26-31 (Control Group)2008-102011-13p value2014p-value2008-102011-13p-value2014 (p-value)Overall9.9%8.0%<0.014.9%<0.018.0%8.5%0.105.6% (<0.01)White9.8%7.5%<0.014.3%<0.017.9%8.5%0.095.3% (<0.01)Black13.4%15.6%0.2211.0%0.0811.8%12.8%0.4510.0% (0.08)High Income Counties9.5%7.5%<0.014.7%<0.017.6%7.9%0.435.1% (<0.01)Low Income Counties12.2%10.8%0.276.2%<0.019.9%11.8%0.038.3% (<0.01) Open table in a new tab