Analysis reveals improved cancer survival for young adults after passage of Affordable Care Act

The federal Patient Protection and Affordable Care Act (ACA) passed in 2010 includes a Dependent Coverage Expansion (DCE) provision that permits dependents to remain on their parents’ health insurance plans from age 19 to 25 years, the age group that has historically had the highest uninsured rate in the United States.

An analysis reveals that during the ACA’s first decade, survival rates of DCE-eligible young adults with cancer have improved. The findings are published online in Cancer.

To examine whether young adults with cancer diagnoses have benefited from the ACA DCE, a team led by Archie Bleyer, MD of Oregon Health & Science University obtained cancer death data for the entire United States from the Centers for Disease Control and Prevention, along with survival information of patients diagnosed with cancer from the Surveillance, Epidemiology, and End Results database (which represents 42–44% of the country).

The researchers assessed changes in cancer survival and mortality pre- and post-ACA enactment in patients aged 19–25 years, and they compared these trends with those for younger and older age groups: ages 12–18 and 26–32 years.

The DCE-eligible group was the only age group of the three to have had improvements in both cancer survival and death rate trends after ACA implementation. Also, 2010, the year the ACA was passed, was the inflection year for both survival and deaths in this group.

After ACA enactment, the six-year relative survival rate was 2.6- and 3.9-times greater in the DCE-eligible age group of 19–25 year-olds compared with the younger and older age groups, respectively.

In comparing post-ACA with pre-ACA cancer-related death rates from 2010–2021, within 12 years after ACA enactment, the DCE-eligible group had the greatest decrease: 2.1- and 1.5-times greater than the younger and older age groups, respectively.

“Within just 10 years after its passage, the DCE has allowed young adults with cancer who were covered by it to live longer and more likely be cured. The DCE and Medicaid should not only be continued but expanded to enable more Americans to be diagnosed earlier, require less therapy, and, for those diagnosed later with their disease, to live longer and have higher cure rates,” said Dr. Bleyer.

“Moreover, other serious physical or mental diseases are likely also having better outcomes since the ACA DCE and should be similarly evaluated, which could strengthen the need even more for ACA and Medicaid coverage and expansion.”