University of California San Francisco
Helen Diller Family Comprehensive Cancer Center

Axing the ACA Means Young Adults with Cancer Lose Coverage

Exclusion from Parentsʻ Insurance May Lead to Life-Threatening Lapses in Chemo, Radiation, UCSF-CHOP Study Shows

By Suzanne Leigh | | October 22, 2020

Axing the ACA Means Young Adults with Cancer Lose Coverage

A new study led by UCSF Benioff Children’s Hospitals and the Children’s Hospital of Philadelphia (CHOP) has quantified the impact of repealing the 2010 Affordable Care Act (ACA), which enables 18- to 25-year-olds to remain on their parents insurance plans, including cancer patients who require long-term medical follow-up.  

In the study, which publishes in JCO Oncology Practice on Oct. 22, 2020, researchers found that patients with a pediatric cancer who were protected under the ACA’s dependent coverage provision were more likely to remain on private insurance for longer durations compared to their older peers who turned 19 before the Act. 

The study builds on previous UCSF research showing that children who are covered by private health insurance have better outcomes than those who are not, the authors said, and heightens concern that upcoming U.S. Supreme Court rulings could lead to the ACA being dismantled. 

“The dependent coverage provision is important for all young adults and critical for survivors of pediatric cancer who require intensive treatment and long-term follow-up for many years after remission,” said first author Lena Winestone, MD, of the UCSF Division of Allergy, Immunology and BMT, and the UCSF Helen Diller Family Comprehensive Cancer Center.  

“Many of the patients followed in the study were on active cancer treatment,” Winestone said. “We know that even brief disruptions in insurance have been associated with harmful health consequences. Strict adherence to chemotherapy regimens, for example, is essential for those patients with acute lymphoblastic leukemia,” which is the most common type of pediatric cancer.  

Protections to Young Adult Patients with Cancer  

The researchers accessed administrative claims from a database covering a large population of geographically diverse, commercially insured enrollees. From this data, they tracked adults who were born in 1982 or later, had been diagnosed with pediatric cancer between 2000 and 2015, and had private insurance prior to diagnosis. Most patients had leukemia (acute lymphoblastic and acute myeloid), lymphoma (Hodgkin and non-Hodgkin), or tumors of the brain or spine.