Improved survival and decreased cancer deaths in young adults with cancer after passage of the Affordable Care Act Dependent Coverage Expansion

Michael Roth; Clark R Andersen; Amy Berkman; Stuart Siegel; Branko Cuglievan; J Andrew Livingston; Michelle Hildebrandt; Jaime Estrada; Archie Bleyer

doi:10.1002/cncr.35538

Improved survival and decreased cancer deaths in young adults with cancer after passage of the Affordable Care Act Dependent Coverage Expansion

Cancer. 2024 Oct 7. doi: 10.1002/cncr.35538. Online ahead of print.

Authors

Michael Roth¹, Clark R Andersen², Amy Berkman³, Stuart Siegel⁴, Branko Cuglievan¹, J Andrew Livingston^{1

5}, Michelle Hildebrandt⁶, Jaime Estrada⁷, Archie Bleyer^{8

9}

Affiliations

¹ Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
² Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
³ Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
⁴ Adolescent and Young Adult Cancer Coalition, Brentwood, Tennessee, USA.
⁵ Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁶ Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
⁷ Texas Doctors for Social Responsibility, San Antonio, Texas, USA.
⁸ Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA.
⁹ Department of Pediatrics, McGovern Medical School, University of Texas, Houston, Texas, USA.

PMID: 39370757
DOI: 10.1002/cncr.35538

Abstract

Background: The Patient Protection and Affordable Care Act (ACA) allowed Americans aged 19-25 years to remain on their parents' health insurance plans until age 26 years (the Dependent Care Expansion [DCE]). Have those with cancer diagnoses benefited?

Methods: The ACE DCE 7-year age range of 19-25 years was compared for changes in cancer survival and mortality before and after enactment of the ACA with groups that were younger and older (in 7-year age spans: ages 12-18 and 26-32 years, respectively). Cancer death data for the entire United States were obtained from the Centers for Disease Control and Prevention, and relative survival data of patients who were diagnosed with cancer were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results regions representing 42%-44% of the country.

Results: Joinpoint analysis identified the DCE-eligible cohort as the only age group of the three groups evaluated that have had improvements in both cancer survival and death rate trends after ACA implementation and that 2010, the year the ACA was passed, was the inflection year for both survival and deaths. By 6 years, the relative survival after cancer diagnosis was 2.6 and 3.9 times greater in the DCE-eligible age group than in the younger and older control groups, respectively (both p < .001), and the cancer death rate in the DCE-eligible age group improved 2.1 and 1.5 times greater than in the younger and older control age groups, respectively (both p < .01).

Conclusions: During the first decade of the ACA, eligible young adults with cancer have had significantly improved survival and mortality. Additional policies expanding insurance coverage and enabling earlier cancer diagnosis among young adults are needed.

Plain language summary: The Patient Protection and Affordable Care Act (ACA) Dependent Care Expansion (DCE) that began in the United States in 2011 allowed young adults aged 19-25 years to remain on their parents' health insurance plans until age 26 years. The survival rate at 6 years in young adult patients diagnosed with cancer was 2.6 to 3.9 times greater in the DCE-eligible age group compared with the younger and older age groups, and the rate of deaths from cancer improved 1.5 to 2.1 times more. During the first decade of the ACA, young adults with cancer who were in the eligible group had significantly longer survival and reduced deaths from cancer. Additional policies that expand insurance coverage and allow the diagnosis of cancer sooner are needed in young adults.

Keywords: Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA DCE); cancer; deaths; health insurance; state Medicaid; survival; young adults.