Purpose To examine change in the percent uninsured and early-stage diagnosis among nonelderly patients with newly diagnosed cancer after the Affordable Care Act (ACA). Patients and Methods By using the National Cancer Data Base, we estimated absolute change (APC) and relative change in percent uninsured among patients with newly diagnosed cancer age 18 to 64 years between 2011 to the third quarter of 2013 (pre-ACA implementation) and the second to fourth quarter of 2014 (post-ACA) in Medicaid expansion and nonexpansion states by family income level. We also examined demographics-adjusted difference in differences in APC between Medicaid expansion and nonexpansion states. We similarly examined changes in insurance and early-stage diagnosis for the 15 leading cancers in men and women (top 17 cancers total). Results Between the pre-ACA and post-ACA periods, percent uninsured among patients with newly diagnosed cancer decreased in all income categories in both Medicaid expansion and nonexpansion states. However, the decrease was largest in low-income patients who resided in expansion states (9.6% to 3.6%; APC, -6.0%; 95% CI, -6.5% to -5.5%) versus their counterparts who resided in nonexpansion states (14.7% to 13.3%; APC, -1.4%; 95% CI, -2.0% to -0.7%), with an adjusted difference in differences of -3.3 (95% CI, -4.0 to -2.5). By cancer type, the largest decrease in percent uninsured occurred in patients with smoking- or infection-related cancers. A small but statistically significant shift was found toward early-stage diagnosis for colorectal, lung, female breast, and pancreatic cancer and melanoma in patients who resided in expansion states. Conclusion Percent uninsured among nonelderly patients with newly diagnosed cancer declined substantially after the ACA, especially among low-income people who resided in Medicaid expansion states. A trend toward early-stage diagnosis for select cancers in expansion states also was found. These results reinforce the importance of policies directed at providing affordable coverage to low-income, vulnerable populations.

中文翻译：

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平价医疗法案后非老年癌症患者的保险覆盖范围和诊断阶段的变化

目的 旨在检查平价医疗法案 (ACA) 颁布后，新诊断为癌症的非老年患者中未投保和早期诊断百分比的变化。患者和方法 通过使用国家癌症数据库，我们估计了 2011 年至 2013 年第三季度（ACA 实施前）新诊断癌症患者年龄在 18 至 64 岁之间的绝对变化 (APC) 和未投保百分比的相对变化，以及2014 年第二至第四季度（ACA 后）按家庭收入水平划分的医疗补助扩张和非扩张州。我们还研究了人口统计学调整后的医疗补助扩张和非扩张状态之间 APC 差异的差异。我们类似地检查了男性和女性 15 种主要癌症（总共前 17 种癌症）的保险和早期诊断的变化。结果在 ACA 之前和 ACA 之后期间，在医疗补助扩张和非扩张状态下，所有收入类别的新诊断癌症患者的未投保百分比均下降。然而，与居住在非扩张状态的低收入患者相比，居住在扩张状态的低收入患者的下降幅度最大（9.6% 至 3.6%；APC，-6.0%；95% CI，-6.5% 至 -5.5%）。 14.7% 至 13.3%；APC，-1.4%；95% CI，-2.0% 至 -0.7%），调整后差异为 -3.3（95% CI，-4.0 至 -2.5）。按癌症类型，吸烟或感染相关癌症患者的未投保百分比下降幅度最大。在处于扩张状态的患者中，发现了对结直肠癌、肺癌、女性乳腺癌、胰腺癌和黑色素瘤的早期诊断的微小但具有统计学意义的转变。结论 在 ACA 之后，新诊断癌症的非老年患者中未投保的百分比大幅下降，特别是在居住在医疗补助扩张州的低收入人群中。还发现了对处于扩张状态的特定癌症进行早期诊断的趋势。这些结果强调了旨在为低收入、弱势群体提供负担得起的保险的政策的重要性。