Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end‐of‐life care than their counterparts with health insurance coverage. On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law, representing the largest change to health care delivery in the United States since the introduction of the Medicare and Medicaid programs in 1965. The primary goals of the ACA are to improve health insurance coverage, the quality of care, and patient outcomes, and to maintain or lower costs by catalyzing changes in the health care delivery system. In this review, we describe the main components of the ACA, including health insurance expansions, coverage reforms, and delivery system reforms, provisions within these components, and their relevance to cancer screening and early detection, care, and outcomes. We then highlight selected, well‐designed studies examining the effects of the ACA provisions on coverage, access to cancer care, and disparities throughout the cancer control continuum. Finally, we identify research gaps to inform evaluation of current and emerging health policies related to cancer outcomes.

中文翻译：

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《平价医疗法案》和整个癌症控制过程中获得医疗服务的机会：10 年回顾

在美国，缺乏健康保险与较差的癌症结果密切相关。与有健康保险的同行相比，未参保者不太可能获得及时有效的癌症预防、筛查、诊断、治疗、生存和临终关怀。2010 年 3 月 23 日，患者保护和平价医疗法案 (ACA) 签署成为法律，这是自 1965 年引入医疗保险和医疗补助计划以来美国医疗保健提供的最大变化。 ACA 将通过促进医疗保健提供系统的变化来改善健康保险覆盖范围、护理质量和患者结果，并维持或降低成本。在这篇综述中，我们描述了 ACA 的主要组成部分，包括健康保险扩展、覆盖改革和交付系统改革，这些组成部分中的规定，以及它们与癌症筛查和早期检测、护理和结果的相关性。然后，我们重点选择了精心设计的研究，这些研究检查了 ACA 条款对覆盖范围、获得癌症护理的机会以及整个癌症控制过程中的差异的影响。最后，我们确定研究差距，以告知与癌症结果相关的当前和新兴卫生政策的评估。