title: The Impact of the Affordable Care Act on North Carolinian Breast Cancer Patients Seeking Financial Support for Treatment.
abstract: The Affordable Care Act (ACA) was instated on 23 March 2010 to improve healthcare quality, reduce costs, and increase access. The Pretty in Pink Foundation (PIPF), a non-profit 501(C)(3) organization in North Carolina, provides financial assistance and in-kind support to individuals seeking help with breast cancer care. The objective of this study was to determine whether sociodemographic variables and treatment services varied among PIPF recipients since enactment of the ACA.
  
  
  
  North Carolinians who received financial assistance from the PIPF between 1 January 2013 and 31 December 2014 were included in the study, and the cohort was divided into two groups based on receipt of assistance before or after the enactment of the ACA. Descriptive statistics were tabulated as frequencies. Comparative univariate analysis between both groups was conducted using the χ (2) and Mann-Whitney U tests. All tests were two-sided and a p value <0.05 was considered statistically significant. All analyses were conducted using Stata.
  
  
  
  Overall, 1016 individuals fulfilled the inclusion criteria, and the median age of the cohort was 49 years (interquartile range 45-55). The ACA groups did not differ significantly by age, race, and sex; however, the groups varied with respect to income, employment, and clinical stage. In addition, the groups differed on the types of services for which they received financial assistance, but no difference was observed between groups with respect to insurance status.
  
  
  
  Since the enactment of the health insurance market component of the ACA, there has been a reduction in subjects receiving assistance from the PIPF; however, no change in their insurance status has been observed.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Samilia
authors.initials: S
authors.lastname: Obeng-Gyasi
authors.affiliation: Department of Surgery, Duke Raleigh Hospital, Raleigh, NC, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Tolnitch
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Greenup
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC, USA. shelley.hwang@duke.edu.
authors.forename: E
authors.initials: E
authors.lastname: Shelley Hwang
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D005378:Financial Support; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D009657:North Carolina; D009939:Organizations, Nonprofit / Q000706:statistics & numerical data* / Q000639:trends*; D058991:Patient Protection and Affordable Care Act