ACA Has Impacted Colorectal Cancer Diagnosis, Treatment in Younger Adults

The dependent coverage expansion provision under the Affordable Care Act (ACA) has led to earlier diagnosis and better care among young patients with colorectal cancer (CRC), according to a study published in the Journal of the National Cancer Institute.

The dependent coverage expansion provision took effect in in 2010 and allows adults through 26 years of age to remain on their parents’ health insurance.

The retrospective study assessed data from the National Cancer Database to identify 10,237 young adults diagnosed with CRC between 2007 and 2013. The cohort included 1,924 patients aged 19 to 25 years who were eligible under the dependent coverage expansion provision and 8,313 patients aged 27 to 34 years who were not eligible.

Early diagnosis, timelier treatment post-ACA

Following implementation of the ACA, there was a statistically significant increase in early-stage diagnosis among dependent coverage expansion-eligible patients, from 12.8% pre-ACA to 27.8% post-ACA (15 percentage point increase; P<0.001). This was not observed among patients who were not eligible for the dependent coverage expansion (P=0.09).

Patients who underwent surgery for stage IIB or IIIC CRC who were eligible for dependent coverage expansion were more likely to receive timely adjuvant chemotherapy (hazard ratio [HR], 1.34; 95% CI, 1.05-1.71; P=0.01), while there were with no differences in timely chemotherapy for non-eligible patients pre- and post-ACA (HR, 1.10; 95% CI, 0.98-1.24; P=0.41).

Among dependent coverage expansion-eligible patients, the restricted mean time from surgery to chemotherapy decreased from 57.4 days pre-ACA to 50.4 days post-ACA.