Long-term impact of the Affordable Care Act's dependent coverage mandate on young women with gynecologic cancer

Abstract

BackgroundThe dependent coverage mandate in the 2010 Affordable Care Act (ACA) allows young adults to stay on a parent's private insurance through age 26. While this mandate is associated with gains in insurance and early-stage cancer diagnosis, its long-term impact on survival is unknown. ObjectiveTo compare insurance coverage, stage at diagnosis, and overall survival in patients with gynecologic cancer before and after the ACA's dependent coverage mandate. MethodsUsing difference-in-differences (DiD) analysis, we conducted a retrospective cohort study comparing outcomes before and after the implementation of the ACA's dependent coverage mandate in young patients with gynecologic cancer, ages 18–26 years (exposure group) to patients ages 27–35 (control group). We analyzed insurance coverage, stage at diagnosis, and 1, 2, and 3-year overall survival, adjusted for age and comorbidities, utilizing the 2004–2017 National Cancer Database. IRB exemption was obtained. ResultsA total of 3553 cases pre-reform and 4535 cases post-reform were identified for patients 18–26 years compared to 14,420 pre-reform and 19,821 post-reform for patients age 27–35. The ACA's dependent coverage mandate was associated with significant gains in insurance (DiD 2%, 95% CI 0.6–3.5) and early-stage diagnosis (3.1%, 95% CI 0.6–5.7). The ACA's dependent coverage mandate was associated with significant gains in 3-year survival (2.4%, 95% CI 0.4–4.3) and non-significant gains in 1 and 2-year survival. ConclusionThe ACA's dependent coverage mandate is associated with improvements in early-stage diagnosis and survival for young patients with gynecologic cancer. Maintaining insurance gains—and expanding to the remaining uninsured—are critical for the health of young patients with gynecologic cancer.