title: The Affordable Care Act and Expanded Insurance Eligibility Among Nonelderly Adult Cancer Survivors.
abstract: BACKGROUND
  Cancer survivors may face barriers to accessing health insurance and experience financial hardship because of medical expenditures. We examined potential improvements in access to insurance for cancer survivors through adult Medicaid expansions and premium tax credits in the new insurance marketplaces under the Affordable Care Act (ACA).
  
  
  METHODS
  Eligibility for Medicaid and premium tax credits was simulated for cancer survivors age 18 to 64 years in the 2008 to 2010 Medical Expenditure Panel Survey using a detailed deterministic model. Financial hardship was determined as: 1) delays or unmet need for medical, prescription, or dental care because of cost or insurance issues and/or 2) family out-of-pocket medical spending that was 20% or more of gross income. Descriptive analyses were stratified by whether the state of residence chose to expand Medicaid by January 2015. All statistical tests were two-sided.
  
  
  RESULTS
  Overall, 14.7% of 9.44 million cancer survivors were uninsured, with 18% reporting financial hardship. Under the ACA, 19% overall, 30% of the uninsured, and 39% of those reporting financial hardship would be Medicaid eligible. An additional 10% would be eligible for premium tax credits, with the remainder able to participate in the Marketplace without tax credits. However, 21% of uninsured cancer survivors in states not expanding Medicaid would be ineligible for assistance with coverage.
  
  
  CONCLUSIONS
  Under the ACA, many of the uninsured and a larger proportion of survivors facing financial hardship will be eligible for Medicaid or premium tax credits in the Marketplaces. ACA implementation will dramatically enhance insurance availability and is likely to reduce financial hardship for vulnerable cancer survivors.
authors.affiliation: Yale School of Public Health, New Haven, CT (AJD); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (SCH); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (DB); Health Services and Economics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY). amy.davidoff@yale.edu.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.affiliation: Yale School of Public Health, New Haven, CT (AJD); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (SCH); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (DB); Health Services and Economics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY).
authors.forename: Steven C
authors.initials: SC
authors.lastname: Hill
authors.affiliation: Yale School of Public Health, New Haven, CT (AJD); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (SCH); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (DB); Health Services and Economics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY).
authors.forename: Didem
authors.initials: D
authors.lastname: Bernard
authors.affiliation: Yale School of Public Health, New Haven, CT (AJD); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (SCH); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (DB); Health Services and Economics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY).
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
mesh_terms: D000328:Adult; D003198:Computer Simulation; D004608:Eligibility Determination; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007182:Income; D019458:Insurance Coverage / Q000191:economics* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics*; D058991:Patient Protection and Affordable Care Act; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States