Nogueira Leticia M, Chawla Neetu, Han Xuesong, Jemal Ahmedin, Yabroff K Robin
JNCI Cancer Spectr. 2019 Jan 15;3(1):pkz001. doi: 10.1093/jncics/pkz001. eCollection 2019 Mar.
The dependent coverage expansion (DCE) and Medicaid expansions (ME) under the Affordable Care Act (ACA) may differentially affect eligibility for health insurance coverage in young adult cancer patients. Studies examining temporal patterns of coverage changes in young adults following these policies are lacking. We used data from the National Cancer Database 2003-2015 to conduct a quasi-experimental study of cancer patients ages 19-34 years, grouped as DCE-eligible (19- to 25-year-olds) and DCE-ineligible (27- to 34-year-olds). Although private insurance coverage in DCE-eligible cancer patients increased incrementally following DCE implementation (0.5 per quarter; < .001), an immediate effect on Medicaid coverage gains was observed after ME in all young adult cancer patients (3.01 for DCE-eligible and 1.62 for DCE-ineligible, both < .001). Therefore, DCE and ME each had statistically significant and distinct effects on insurance coverage gains. Distinct temporal patterns of ACA policies' impact on insurance coverage gains likely affect patterns of receipt of cancer care. Temporal patterns should be considered when evaluating the impact of health policies.
《平价医疗法案》（ACA）下的受抚养人保险范围扩大（DCE）和医疗补助扩大（ME）可能会对年轻成年癌症患者的医疗保险资格产生不同影响。目前缺乏对这些政策实施后年轻人保险覆盖范围变化时间模式的研究。我们使用了2003年至2015年国家癌症数据库的数据，对19至34岁的癌症患者进行了一项准实验研究，分为符合DCE资格（19至25岁）和不符合DCE资格（27至34岁）两组。尽管符合DCE资格的癌症患者在DCE实施后私人保险覆盖范围逐步增加（每季度增加0.5；<0.001），但在所有年轻成年癌症患者中，ME实施后立即观察到医疗补助覆盖范围增加的效果（符合DCE资格的为3.01，不符合DCE资格的为1.62，均<0.001）。因此，DCE和ME对保险覆盖范围增加均有统计学上显著且不同的影响。ACA政策对保险覆盖范围增加的不同时间模式可能会影响癌症护理的接受模式。在评估卫生政策的影响时应考虑时间模式。
