Division of Allergy, Immunology, and Blood & Marrow Transplant, Department of Pediatrics, University of California San Francisco (UCSF) Benioff Children's Hospital; and UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, PA.
JCO Oncol Pract. 2021 Jun;17(6):e882-e890. doi: 10.1200/OP.20.00330. Epub 2020 Oct 22.
The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act (ACA) allowed enrollees to remain on their parents' health insurance until 26 years of age. We compared rates of insurance disenrollment among patients with cancer who were DCP-eligible at age 19 to those who were not eligible at age 19.
Using OptumLabs Data Warehouse, which contains longitudinal, real-world, de-identified administrative claims for commercial enrollees, we examined patients born between 1982 and 1993 and diagnosed with cancer between 2000 and 2015. In the recent cohort, patients who turned 19 in 2010-2012 (DCP-eligible to stay on parents' insurance) were matched to patients who turned 19 in 2007-2009 (not DCP-eligible when turning 19). In an earlier control cohort, patients who turned 19 between 2004 and 2006 (not DCP-eligible) were matched to patients who turned 19 between 2001 and 2003 (not DCP-eligible). Patients were matched on cancer type, diagnosis date, demographics, and treatment characteristics. The time to loss of coverage was estimated using Cox models. Difference-in-difference between the recent and earlier cohorts was also evaluated.
A total of 2,829 patients who turned 19 years of age in 2010-2012 were matched to patients who turned 19 in 2007-2009. Median time to disenrollment was 26 months for younger patients versus 22 months for older patients (hazard ratio [HR], 0.85; 95% CI, 0.80 to 0.90; = .001). In 8,978 patients who turned 19 between 2001 and 2006, median time to disenrollment was 20 months among both younger and older patients (HR, 0.99; 95% CI, 0.94 to 1.03; = .59). The difference between the recent cohort and the earlier control cohort was a 15% greater reduction in coverage loss ( < .0001), favoring those turning 19 after the DCP went into effect.
In the vulnerable population of adolescent and young adult cancer survivors, the ACA may have lowered the insurance dropout rate.
平价医疗法案（ACA）的 2010 年依赖覆盖条款（DCP）允许参保人在 26 岁之前继续使用父母的医疗保险。我们比较了在 19 岁时符合 DCP 条件和不符合条件的癌症患者的保险退保率。
利用 OptumLabs 数据仓库，该数据库包含商业参保者的纵向、真实世界、去标识化的行政索赔数据，我们检查了在 1982 年至 1993 年之间出生，并在 2000 年至 2015 年之间被诊断患有癌症的患者。在最近的队列中，2010-2012 年年满 19 岁（符合条件留在父母的保险）的患者与 2007-2009 年年满 19 岁（19 岁时不符合条件）的患者相匹配。在较早的对照组中，2004-2006 年年满 19 岁（不符合 DCP 条件）的患者与 2001-2003 年年满 19 岁（不符合 DCP 条件）的患者相匹配。患者按癌症类型、诊断日期、人口统计学特征和治疗特征进行匹配。使用 Cox 模型估计覆盖范围丧失的时间。还评估了最近队列和较早队列之间的差异。
共有 2829 名在 2010-2012 年年满 19 岁的患者与 2007-2009 年年满 19 岁的患者相匹配。年轻患者的退保中位时间为 26 个月，而年龄较大患者的退保中位时间为 22 个月（风险比[HR]，0.85；95%置信区间，0.80 至 0.90； <.001）。在 2001-2006 年年满 19 岁的 8978 名患者中，年轻和年龄较大患者的退保中位时间均为 20 个月（HR，0.99；95%置信区间，0.94 至 1.03； =.59）。最近队列与较早对照组之间的差异为，覆盖范围损失减少了 15%（ <.0001），这有利于 DCP 生效后年满 19 岁的人群。
在青少年和年轻成年癌症幸存者这一弱势群体中，ACA 可能降低了保险退保率。
