The Affordable Care Act and income-based disparities in health care coverage and spending among nonelderly adults with cancer.

Health affairs scholar Pub Date : 2024-04-25 eCollection Date: 2024-05-01 DOI:10.1093/haschl/qxae050
Olajumoke A Olateju, Chan Shen, James Douglas Thornton
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Abstract

The Patient Protection and Affordable Care Act (ACA) significantly reduced uninsured individuals and improved financial protection; however, escalating costs of cancer treatment has led to substantial out-of-pocket expenses, causing severe financial and mental health distress for individuals with cancer. Mixed evidence on the ACA's ongoing impact highlights the necessity of assessing health-spending changes across income groups for informed policy interventions. In our nationally representative survey evaluating the early- and long-term effects of the ACA on nonelderly adult patients with cancer, we categorized individuals-based income subgroups defined by the ACA for eligibility. We found that ACA implementation increased insurance coverage, which was particularly evident after 2 years of implementation. Early post-ACA (within two years of implementation), there were declines in out-of-pocket spending for the lowest and low-income groups by 26.52% and 38.31%, respectively, persisting long-term only for the lowest-income group. High-income groups experienced continuously increased out-of-pocket and premium spending by 25.39% and 34.28%, respectively, with a notable 122% increase in the risk of high-burden spending. This study provides robust evidence of income-based disparities in financial burden for cancer care, emphasizing the need for health care policies promoting equitable care and addressing spending disparities across income brackets.

平价医疗法案》与非老年成人癌症患者在医疗保险和支出方面的收入差距。
患者保护与平价医疗法案》(ACA)大大减少了未参保人员的数量,并改善了财务保护;然而,癌症治疗费用的不断攀升导致了大量的自付费用,给癌症患者造成了严重的财务和心理健康困扰。关于《美国医疗保险法案》持续影响的证据不一,这凸显了评估不同收入群体的医疗支出变化以进行知情政策干预的必要性。在我们的全国代表性调查中,我们评估了 ACA 对非老年成年癌症患者的早期和长期影响,并根据 ACA 规定的资格对个人收入分组进行了分类。我们发现,ACA 的实施提高了保险覆盖率,这一点在实施两年后尤为明显。在《全美医疗保险法案》实施后的早期(实施两年内),最低收入组和低收入组的自付支出分别下降了 26.52% 和 38.31%,只有最低收入组的自付支出长期持续下降。高收入群体的自付支出和保费支出分别持续增加了 25.39% 和 34.28%,高负担支出的风险显著增加了 122%。这项研究提供了有力的证据,证明癌症治疗的经济负担存在着基于收入的差异,强调有必要制定促进公平治疗的医疗政策,解决不同收入阶层的支出差异问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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