ACA Medicaid Expansion Linked To Decrease in Uninsured Cancer Patients Interview with:

Aparna Soni, MA Department of Business Economics and Public Policy Kelley School of Business Indiana University, Bloomington

Aparna Soni

Aparna Soni, MA
Department of Business Economics and Public Policy
Kelley School of Business
Indiana University, Bloomington What is the background for this study? What are the main findings?

Response: Cancer is the leading cause of death among the non-elderly population in the United States. Unfortunately, uninsured people are less likely to get screened for cancer, and treatment is often unaffordable for those who are uninsured.

One of the key objectives of the Affordable Care Act (ACA) was to improve outcomes for cancer patients. Our objective in this study was therefore to assess changes under the ACA in insurance coverage among patients newly diagnosed with cancer.

Our main finding is that uninsurance among patients with newly diagnosed cancer fell by one-third in 2014. What should readers take away from your report?

Response: The key take-away from our study is that the general increase in insurance coverage seen in national ACA analyses extends to this high-risk population of cancer patients. Coverage gains were largely driven by increased insurance in states that participated in the Medicaid expansion. We found that after adjusting for patient and county characteristics, the percentage of uninsured first-time cancer patients dropped from 5.0% in 2013 to 2.5% in 2014 in the Medicaid expansion states, whereas the percentage uninsured did not significantly change in the non-expansion states.  What are the implications of your analysis for policymakers?

Response: As the nation continues to debate health care reform, our findings suggest that reducing Medicaid funding or weakening protections for individuals with preexisting conditions could reduce insurance coverage for patients with cancer.  What recommendations do you have for future research as a result of this study?

Response: This study is the first step of our broader research plan which aims to assess the impacts of the ACA on disparities in cancer outcomes. We found that uninsurance among cancer patients fell by one-third in the first full year of ACA implementation. The next step is to understand the extent to which this increased coverage affected cancer screening, treatment, and outcomes. Is there anything else you would like to add?

Response: The data for this study came from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program. One limitation of this dataset is that it includes data from only 13 states, and we currently have only one year of data post-ACA. Nevertheless, the SEER covers approximately 28% of the US population and is considered the most comprehensive source for studying cancer diagnosis in the geographic regions that it does cover. Thank you for your contribution to the community.


Soni A, Sabik LM, Simon K, Sommers BD. Changes in Insurance Coverage Among Cancer Patients Under the Affordable Care Act. JAMA Oncol. Published online October 19, 2017. doi:10.1001/jamaoncol.2017.3176

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 

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Last Updated on October 20, 2017 by Marie Benz MD FAAD