Expanded health coverage may improve cancer outcomes in young adults, study suggests


Paul Nguyen, MDPaul Nguyen, MD

Young adults who lack health care insurance are more likely to be diagnosed in advanced stages of cancer and have a higher risk of death, according to a study from Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) and Harvard Medical School.

Consequently, the Affordable Care Act (ACA), or Obamacare, may improve cancer outcomes in young adults as it expands coverage to many who have been uninsured, said first author Ayal Aizer, MD, MHS, of the Harvard Radiation Oncology Program and senior author, Paul Nguyen, MD, of Radiation Oncology at DF/BWCC in a report published in the Journal of Clinical Oncology today. Cancer patients will also benefit from the ACA requirement that insurers cover individuals with pre-existing conditions.

“We found that patients who have insurance coverage do better on every measure,” said Aizer. Those who had insurance coverage were less likely to come to medical attention when their cancer had metastasized, or spread beyond the original site. The results showed that 11.3 percent of covered individuals had metastatic disease when they were diagnosed, compared with 18.5 percent of uninsured patients. That amounted to a 16 percent greater adjusted likelihood of having a potentially curable cancer.

Insured patients were about twice as likely to receive “definitive therapy” — radiation or surgery — for their disease. And, strikingly, the insured were 20 percent more likely to survive.

The researchers analyzed records of 39,447 cancer patients ages 20 to 40 years whose medical, demographic and insurance information was stored in a National Cancer Institute-sponsored database.

The vast majority of patients — 93 percent — were insured, while 7 percent, or 2,578, lacked coverage; they tended to be younger, male, non-white and unmarried, and more likely to be from regions of lower median income, educational level, and population density. The study examined relationships between insurance status and several cancer outcomes.

“Overall, the ACA is going to improve health coverage for young people, but we can’t forget about some young people who may feel they can’t afford the premiums,” added Nguyen. The authors wrote in their article that “extra consideration will need to be given to ensure that at-risk patients can obtain insurance coverage under the ACA.”

Premium costs for some young adults who purchase insurance in the individual market are expected to rise substantially. Such individuals often lack employer-sponsored health plans. The higher costs are partly because the coverage under the ACA is required to be more comprehensive than many existing plans, and because the premiums paid by young, healthy people are helping to subsidize lower costs for older adults.

On the other hand, the ACA extends young adults’ coverage under their parents’ health plans until age 26, and federal subsidies will pay part of the premium costs of low-earning consumers.

Aizer said the study was aimed at exploring the ACA’s potential impact on cancer outcomes. The law expands public and private insurance coverage to many previously uninsured patients, requires that all individuals obtain coverage or pay an annual fine, and applies new minimum standards to health policies. The research was funded by a Heritage Medical Research Institute/Prostate Cancer Foundation Young Investigator Award, and other private and foundation grants.

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