Cannon RB, et al. - Among patients with head and neck squamous cell cancer (HNSCC), authors gauged the relationship of the Patient Protection and Affordable Care Act (ACA) health care legislation with rates of insurance coverage and access to care. For patients with HNSCC, access to health care was improved following implementation of the ACA, with higher rates of both Medicaid and private insurance and a 2-fold decrease in the uninsured patient rate. Only states that adopted the Medicaid expansion in 2014 demonstrated these outcomes. Poorer survival outcomes were seen in the uninsured.

Methods

• Experts examined rates of insurance coverage and access to care among 89,038 patients with newly diagnosed HNSCC from January 2007 to December 2014 using the prospectively gathered data from the Surveillance, Epidemiology, and End Results (SEER) database.
• They compared the rates of insurance between states that elected to expand Medicaid coverage in 2014 and states that opted out of the expansion.
• They performed statistical analysis from January 1, 2007 to December 31, 2014.
• Rates of insurance coverage and disease-specific and overall survival were the main outcomes and measures.

Results

• As per data, among 89,038 patients newly diagnosed with HNSCC (29,384 women and 59,654 men; mean [SD] age, 59.8 [7.6] years), there was an increase after the ACA was implemented in the percentage of patients enrolled in Medicaid (16.2% after vs 14.8% before; difference, 1.4%; 95% CI, 1.1%-1.7%) and private insurance (80.7% after vs 78.9% before; difference, 1.8%; 95% CI, 1.2%-2.4%).
• Moreover, the rate of uninsured patients decreased considerably following ACA implementation (3.0% after vs 6.2% before; difference, 3.2%; 95% CI, 2.9%-3.5%).
• Findings suggested that this decrease in the rate of uninsured patients and the associated increases in Medicaid and private insurance coverage were only different in the states that adopted the Medicaid expansion in 2014.
• After implementation of the ACA, no survival data are available, but before that point, from 2007 to 2013, uninsured patients had reduced 5-year overall survival (48.5% vs 62.5%; difference, 14.0%; 95% CI, 12.8%-15.2%) and 5-year disease-specific survival vs insured patients (56.6% vs 72.2%; difference, 15.6%; 95% CI, 14.0%-17.2%).