Financial burden of cancer care under the Affordable Care Act: Analysis of MEPS-Experiences with Cancer Survivorship 2011 and 2016
To examine whether the implementation of Affordable Care Act (ACA) reduced the financial burden associated with cancer care among non-elderly cancer survivors.
Using data from the MEPS-Experiences with Cancer Survivorship Survey, we examined whether there was a difference in financial burden associated with cancer care between 2011 (pre-ACA) and 2016 (post-ACA). Two aspects of financial burden were considered: (1) self-reported financial burden, whether having financial difficulties associated with cancer care and (2) high-burden spending, whether total out-of-pocket (OOP) spending incurred in excess of 10% or 20% of family income. Generalized linear regression models were estimated to adjust the OOP expenditures (reported in 2016 US dollar).
Our sample included adults aged 18–64 with a confirmed diagnosis of any cancer in 2011 (n = 655) and in 2016 (n = 490). There was no apparent difference in the prevalence of cancer survivors reporting any financial hardship or being with high-burden spending between 2011 and 2016. The mean OOP decreased by $268 (95% CI, − 384 to − 152) after the ACA. However, we found that the mean premium payments increased by $421 (95% CI, 149 to 692) in the same period.
The ACA was associated with reduced OOP for health services but increased premium contributions, resulting in no significant impact on perceived financial burden among non-elderly cancer survivors.
Implications for cancer survivors
The financial hardship of cancer survivorship points to the need for the development of provisions that help cancer patients reduce both perceived and materialized burden of cancer care under ongoing health reform.
KeywordsFinancial burden of cancer care Affordable Care Act Out-of-pocket spending Insurance premiums
• Study conception and design: Hong and Huo
• Acquisition, analysis, or interpretation of data: All authors
• Drafting of manuscript: Hong
• Critical revision of the manuscript for important intellectual content: Smith, Mainous, and Huo
• Statistical analysis: Hong and Huo
• Administrative, technical, or material support: Hong and Xie
• Study supervision: Huo and Mainous
Compliance with ethical standards
Conflict of interest
The authors declare that they had no conflict of interest.
This study was deemed exempt from review by the University of Florida Institutional Review Board because the use of publicly available dataset did not constitute human subjects research.
Since we used deidentified data, informed consent from the participants was not required.
- 4.Finkelstein EA, Tangka FK, Trogdon JG, Sabatino SA, Richardson LC. The personal financial burden of cancer for the working-aged population. Am J Manag Care. 2009;15(11):801–6.Google Scholar
- 15.United States Census Bureau. Health insurance coverage in the United States: 2016.Google Scholar
- 20.National Cancer Institute. Medical Expenditure Panel Survey (MEPS): experiences with cancer survivorship supplement. https://healthcaredelivery.cancer.gov/meps/. Published 2018. Accessed October 3, 2018.
- 24.Agency for Healthcare Research and Quality. MEPS HC-192: 2016 Full Year Consolidated Data File. https://meps.ahrq.gov/data_stats/download_data/pufs/h192/h192doc.shtml. Published 2018. Accessed September 28, 2018.
- 26.Agency for Healthcare Research and Quality. MEPS topic-priority condition. https://meps.ahrq.gov/data_stats/MEPS_topics.jsp. Published 2009. Accessed October 15, 2018.
- 27.Deb P, Norton EC. Modeling health care expenditures and use. Annu Rev Public Health. 2018;39(1):489–505. https://doi.org/10.1146/annurev-publhealth-040617-013517.CrossRefGoogle Scholar
- 28.Bureau of Labor Statistics. Medical care in consumer price index. http://data.bls.gov/timeseries/CUUR0000SAM?output_view=pct_12mths. Published 2017. Accessed October 18, 2016.
- 29.Andersen RM, Davidson PL, Baumeister SE. Improving access to care. In: Changing the US Health Care System: key issues in health services policy and management, vol. 2013. San Francisco, CA: Jossey-Bass. p. 33–69.Google Scholar
- 33.Garfield R, Damico A, Stephens J, Rouhani S. The coverage gap: uninsured poor adults in states that do not expand Medicaid - an update. Kaiser Fam Found. 2014;(October:1–8.Google Scholar
- 34.Blumberg L, Holahan J, Wengle E. Increases in 2016 marketplace nongroup premiums: there is no meaningful national average. The Urban Insitute. https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf429398. Published 2016. Accessed October 1, 2018.
- 35.Schleicher SM, Wood NM, Lee S, Feeley TW. How the Affordable Care Act has affected cancer care in the United States: has value for cancer patients improved? Oncology (Williston Park). 2016;30(5):468–74 doi:217053.Google Scholar
- 37.American Society of Clinical Oncology. American Society of Clinical Oncology position statement on addressing the affordability of cancer drugs. https://www.asco.org/sites/new-www.asco.org/files/content-files/blog-release/documents/2017-ASCO-Position-Statement-Affordability-Cancer-Drugs.pdf?et_cid=39454952&et_rid=1760459169&linkid=position+statement. Published 2017. Accessed November 1, 2018.
- 38.The Henry J. Kaiser Family Foundation. The coverage gap: uninsured poor adults in states that do not expand Medicaid. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/. Published 2018. Accessed September 30, 2018.
- 39.Schoen C. The Affordable Care Act and the U.S. economy: a five-year perspective. The Commonwealth Fund. https://www.commonwealthfund.org/publications/fund-reports/2016/feb/affordable-care-act-and-us-economy. Published 2016. Accessed November 1, 2018.