Financial burden of cancer care under the Affordable Care Act: Analysis of MEPS-Experiences with Cancer Survivorship 2011 and 2016

  • Young-Rock HongEmail author
  • Grace L. Smith
  • Zhigang Xie
  • Arch G. MainousIII
  • Jinhai Huo



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.


Financial burden of cancer care Affordable Care Act Out-of-pocket spending Insurance premiums 


Authors’ contribution

• 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.

Ethical approval

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.

Informed consent

Since we used deidentified data, informed consent from the participants was not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health Services Research, Management and PolicyUniversity of FloridaGainesvilleUSA
  2. 2.Department of Radiation Oncology, Division of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Community Health and Family MedicineUniversity of FloridaGainesvilleUSA

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