Hu Xin, Castellino Sharon M, Ji Xu
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):10-19. doi: 10.1182/hematology.2024000528.
The Affordable Care Act (ACA), fully implemented in 2014, introduced reforms to Medicaid and the Children's Health Insurance Program (CHIP), aiming to enhance health care access for vulnerable populations. Key provisions that can influence health outcomes in adolescents and young adults (AYAs) with blood cancers include Medicaid expansion, which covers adults with income less than or equal to 138% of the federal poverty level based on modified adjusted gross income (MAGI), streamlined eligibility and enrollment processes, CHIP and Medicaid integration, and dependent coverage reform. Non-MAGI eligibility pathways based on age, disability, or waiver programs provide alternative routes for Medicaid coverage. By improving insurance coverage, providing affordable care and financial protection, and addressing health-related social needs such as transportation to care, Medicaid expansion has the potential to mitigate outcome disparities along the continuum of AYA blood cancer care. However, challenges persist due to coverage gaps in nonexpansion states, complexities in administrative processes to maintain continuous coverage, and barriers to accessing specialists for complex, AYA-focused multidisciplinary cancer care. The ending of the COVID-19 public health emergency's Medicaid Continuous Enrollment Provision has disrupted coverage for many AYAs. Given limited research evaluating the impact of the ACA on AYA blood cancer outcomes, more evidence is needed to guide future policies tailored to this vulnerable population. Despite encouraging progress following the ACA, continued collaborative efforts between policymakers, health care providers, patient advocates, and researchers are essential for identifying targeted strategies to ensure continuous and affordable coverage, access to specialized and coordinated care, and fewer disparities in AYA blood cancer outcomes.
《平价医疗法案》（ACA）于2014年全面实施，对医疗补助计划和儿童健康保险计划（CHIP）进行了改革，旨在改善弱势群体的医疗保健服务可及性。可能影响青少年和青年成人（AYA）血癌患者健康结局的关键条款包括医疗补助计划扩大，该计划覆盖收入低于或等于基于调整后总收入（MAGI）计算的联邦贫困水平138%的成年人，简化了资格认定和参保流程，CHIP与医疗补助计划整合，以及受抚养人保险改革。基于年龄、残疾或豁免计划的非MAGI资格认定途径为医疗补助覆盖提供了替代途径。通过改善保险覆盖范围、提供可负担的医疗服务和经济保护，以及解决诸如就医交通等与健康相关的社会需求，医疗补助计划扩大有可能减轻AYA血癌治疗全过程中的结局差异。然而，由于未扩大医疗补助计划的州存在覆盖缺口、维持连续参保的行政流程复杂，以及在获得针对复杂的、以AYA为重点的多学科癌症治疗的专科医生服务方面存在障碍，挑战依然存在。新冠疫情公共卫生紧急状态下的医疗补助计划连续参保条款的结束扰乱了许多AYA的保险覆盖。鉴于评估ACA对AYA血癌结局影响的研究有限，需要更多证据来指导针对这一弱势群体的未来政策。尽管ACA实施后取得了令人鼓舞的进展，但政策制定者、医疗服务提供者、患者权益倡导者和研究人员之间持续的合作努力对于确定有针对性的策略至关重要，这些策略要确保连续且可负担的保险覆盖、获得专科和协调的医疗服务，以及减少AYA血癌结局方面的差异。
