ACA helps patients get access to better cancer care

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More patients received care at accredited cancer hospitals once the Affordable Care Act (ACA) expanded options for health insurance, according to a new study of its effects in Pennsylvania.

The ACA made a difference in care for patients, according to a comparison of data from 2010 to 2013, before much of the act’s provisions went into effect, and from 2014 to 2019, according to a news release about the results.

When enacted in 2020, the study said ACA was the largest expansion of health insurance in the nation since the start of Medicare and Medicaid in the 1960s. Four years later, factors affecting care included the 2014 creation of the health insurance marketplaces, ensuring minimal coverage in health insurance policies, and expanding Medicaid eligibility to anyone with an income up to 138% of the federal poverty level.

ACA was a federal law, but the U.S. Supreme Court ruled states could opt to expand Medicaid programs, and 40 have done so, including Pennsylvania.

“Although the ACA is over 10 years old, our findings are relevant because there are continued policy debates about further expanding Medicaid and Medicare and, on the flip side, some policymakers want to roll back elements of the legislation,” senior author Lindsay Sabik, PhD, said in the news release. “For states that have not yet expanded Medicaid, our study suggests that this is important for improving access to high quality cancer care.”

Pennsylvania is in the top 10 nationally for cancer incidence per population, according to the study. Meanwhile, hospital accreditation is important because studies consistently find patients tend to have better outcomes when in treatment at hospitals with cancer-focused designations, according to the study. But additional research has found poor access for patients in rural and socioeconomically disadvantaged areas, and who are racial and ethnic minorities, and who lack health insurance.

The effects involved cancer care, according to researchers who used the Pennsylvania Cancer Registry to identify patients aged 26 to 64 who received surgery as part of their initial treatment for lung, prostate, or colorectal cancer.

Statewide data identified patients who lived in areas with high rates of uninsurance before the ACA provisions, because they would be more likely to use ACA insurance benefits. They compared the percentage of high baseline uninsured patients seeking cancer treatment, with patients in low insurance rate areas.

After the ACA, there was a 6.2% increase in patients from high baseline uninsurance areas seeking care at hospitals accredited by the National Cancer Institute-designated Comprehensive Cancer Center (NCI-CCCs). Pennsylvania had three hospitals with that accreditation.

There was an increase of 3.9% in patients seeking care at hospitals accredited by the American College of Surgeons Commission on Cancer (CoC). Pennsylvania had 56 CoC accreditation, including the three with the NCI-CCC accreditation.

Sabik is associate professor and vice chair for research in the Department of Health Policy and Management at the Pitt School of Public Health and member of the Biobehavioral Cancer Control Program at UPMC Hillman Cancer Center. The U.S. Agency for Healthcare Research and Quality supported the research. The study, “Impact of the Affordable Care Act on access to accredited facilities for cancer treatment,” was published in Health Services Research.