The Affordable Care Act improved health insurance coverage and cardiovascular-related screening rates for cancer survivors seen in community health centers.

Autor: Angier HE; Family Medicine, Oregon Health & Science University, Portland, Oregon., Marino M; Family Medicine, Oregon Health & Science University, Portland, Oregon., Springer RJ; Family Medicine, Oregon Health & Science University, Portland, Oregon., Schmidt TD; Research, OCHIN, Inc, Portland, Oregon., Huguet N; Family Medicine, Oregon Health & Science University, Portland, Oregon., DeVoe JE; Family Medicine, Oregon Health & Science University, Portland, Oregon.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2020 Jul 15; Vol. 126 (14), pp. 3303-3311. Date of Electronic Publication: 2020 Apr 15.
DOI: 10.1002/cncr.32900
Abstrakt: Background: This study assessed the impact of Affordable Care Act (ACA) Medicaid expansion on health insurance rates and receipt of cardiovascular-related preventive screenings (body mass index, glycated hemoglobin [HbA1c], low-density lipoproteins, and blood pressure) for cancer survivors seen in community health centers (CHCs).
Methods: This study identified cancer survivors aged 19 to 64 years with at least 3 CHC visits in 13 states from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE). Via inverse probability of treatment weighting multilevel multinomial modeling, insurance rates before and after the ACA were estimated by whether a patient lived in a state that expanded Medicaid, and changes between a pre-ACA time period and 2 post-ACA time periods were assessed.
Results: The weighted estimated sample size included 409 cancer survivors in nonexpansion states and 2650 in expansion states. In expansion states, the proportion of uninsured cancer survivors decreased significantly from 20.3% in 2012-2013 to 4.5%in 2016-2017, and the proportion of those with Medicaid coverage increased significantly from 38.8% to 55.6%. In nonexpansion states, there was a small decrease in uninsurance rates (from 33.6% in 2012-2013 to 22.5% in 2016-2017). Cardiovascular-related preventive screening rates increased over time in both expansion and nonexpansion states: HbA1c rates nearly doubled from the pre-ACA period (2012-2013) to the post-ACA period (2016-2017) in expansion states (from 7.2% to 12.8%) and nonexpansion states (from 9.3% to 16.8%).
Conclusions: This study found a substantial decline in uninsured visits among cancer survivors in Medicaid expansion states. Yet, 1 in 5 cancer survivors living in a state that did not expand Medicaid remained uninsured. Several ACA provisions likely worked together to increase cardiovascular-related preventive screening rates for cancer survivors seen in CHCs.
(© 2020 Oregon Health & Science University. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)
Databáze: MEDLINE
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