Kidney Cancer Coverage from Every Angle

Impact of the Affordable Care Act in Renal Cell Carcinoma

By: Julia Fiederlein
Posted: Thursday, February 18, 2021

Insurance expansions implemented through the Patient Protection and Affordable Care Act (ACA) seem to be associated with downward stage migration in low- and middle-income patients with renal cell carcinoma, according to Juan Javier-DesLoges, MD, MS, of UC San Diego Health, La Jolla, California, and colleagues. The results, which were presented in the Best of Kidney Cancer session during the virtual edition of the 2020 Society of Urologic Oncology (SUO) Annual Meeting, suggested these insurance expansions may also be associated with the attenuation of income status as a risk for mortality.

Using the National Cancer Database, the investigators identified 78,099 patients with localized or advanced renal cell carcinoma. States were categorized as either participating on-time in Medicaid expansion or not participating.

After the implementation of the ACA, the absolute percentage change of patients with insurance increased by 4.0% in expansion states and 2.1% in nonexpansion states. Compared with nonexpansion states, the rate of being uninsured declined by 1.1% in expansion states (P < .001). The acquisition of Medicaid by low- (absolute percentage change: 11%; P < .001), middle- (absolute percentage change: 4.2%; P < .001), and high- (absolute percentage change: 4%; P < .001) income patients seemed to increase in expansion states.

In expansion states, a higher proportion of low- (absolute percentage change: 4%; P < .001) and middle- (absolute percentage change: 1.6%; P = .023.) income patients were diagnosed with localized renal cell carcinoma after the implementation of the ACA. Low income seemed to be associated with a higher risk of mortality prior to the ACA; however, after the implementation of this legislation, income status was attenuated as a risk factor.

Disclosure: No information regarding conflicts of interest was provided.

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