Abstract B079: The Affordable Care Act and cancer stage in an underserved population
Authors: Lu Yan , Jackson Bradford E. , Cross Deanna , Neerukonda Latha , Tanna Bhavna , Ghabach Bassam , Ojha Rohit P. 
Published: August 2020

Abstract
Background: The Patient Protection and Affordable Care Act (ACA), particularly provisions enacted in 2014 including the health insurance exchange and Medicaid expansion, aimed to reduce the number of uninsured individuals in the United States. The ACA has increased insurance coverage and improved cancer stage at diagnosis for certain populations, but unknown is the effect of ACA on cancer stage at diagnosis specifically among the underserved (i.e., socioeconomically disadvantaged). Therefore, we aimed to assess the effect of ACA enactment on advanced-stage cancer diagnosis among underserved cancer patients.
Methods: We used data from the JPS Center for Cancer Care institutional registry (accredited by the Commission on Cancer). This center is part of an urban public hospital network that serves Tarrant County, TX (population &gt;2 million) and is a primary source of care for underserved individuals. Our eligible population included individuals aged ≥18 years who were diagnosed with a first primary solid malignancy between 2008 and 2015. We compared the effect of ACA implementation on advanced stage diagnosis for overall, screen-detectable, and non-screen-detectable cancers using a natural experiment framework and interrupted time-series analysis to estimate prevalence differences (PD) and 95% confidence limits (CL), where January 2014 differentiated the pre- and post-ACA periods in 6-month intervals.
Results: Our study population comprised 6,679 underserved patients, of whom 46% were aged &lt;55 years, 55% were female, 25% were non-Hispanic Black, and 24% were Hispanic. Private insurance coverage increased from 4.6% to 10% after ACA enactment. The overall prevalence of advanced stage diagnosis increased 2.5% following ACA enactment (95% CL: -2.0%, 7.0%), which modestly varied for screen-detectable cancers (PD = 4.3%, 95% CL: -0.3%, 8.8%) and non-screen-detectable cancers (PD = 1.4%, CL: -3.7%, 6.6%).
Discussion: Our results do not suggest a reduction in late-stage diagnosis after ACA enactment among underserved cancer patients. The small increase in prevalence of late-stage diagnosis post-ACA could be an initial consequence of increased access to care (i.e., recognition of previously undiagnosed cases) given the small increase in private insurance coverage, but longer follow-up is necessary to interpret this result. Texas did not expand Medicaid coverage as part of ACA enactment, and thus our findings raise questions about whether Medicaid expansion would have affected late-stage diagnosis among underserved cancer patients.
Citation Format: Yan Lu, Bradford E. Jackson, Deanna Cross, Latha Neerukonda, Bhavna Tanna, Bassam Ghabach, Rohit P. Ojha. The Affordable Care Act and cancer stage in an underserved population [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B079.