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Impact of the Affordable Care Act and Medicaid Expansion Among Patients With HIV-Associated Aggressive B-Cell Non-Hodgkin Lymphomas.

Author information

Affiliations

  • 1. Division of Hematology, Oncology and Transplantation, University of Minnesota, Masonic Cancer Center, Minneapolis, MN.
      Authors
    • Premnath N 1
    (1 author)
  • 2. Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX.
      Authors
    • Liu Y 2
    • Nair RG 2
    (2 authors)
  • 3. Section of Hematologic Malignancies and Cellular Therapy, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX.
      Authors
    • Reves H 3
    • Pandey U 3
    • Anderson J 3
    • Afrough A 3
    • Anderson LD Jr 3
    • Chung SS 3
    • Kaur G 3
    • Khan AM 3
    • Madanat YF 3
    • Wolfe HR 3
    • Yilmaz E 3
    • Awan FT 3
    • Sweetenham J 3
    • Ramakrishnan Geethakumari P 3
    (14 authors)
  • 4. Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX.
      Authors
    • Kumar KA 4
    (1 author)

ORCIDs linked to this article

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JCO Oncology Practice, 17 Oct 2024, :OP2400354
https://doi.org/10.1200/op.24.00354 PMID: 39418621 

Abstract 

Purpose

To study the influence of the Affordable Care Act (ACA) policy and its Medicaid expansion on insurance status and survival in patients with HIV with aggressive lymphoma.

Methods

We used the National Cancer Database, a hospital-based national registry, to identify adults age 18-64 years with HIV-associated aggressive B-cell non-Hodgkin lymphomas (HIV-a-B-NHLs), diagnosed during 2007 to 2016. Survival analysis was performed on a subset of patients with HIV-a-B-NHL for whom location data were available who resided in Medicaid expansion-adopted and nonadopted states. Using a quasi-experimental difference-in-difference model, the difference in adjusted 2-year survival rates obtained with a flexible parametric Weibull model was compared for states that adopted the Medicaid expansion of ACA against those that did not adopt the expansion.

Results

We identified 8,231 patients with HIV-a-B-NHL and 50,650 non-HIV patients with a-B-NHL. We found that a lower proportion of individuals were uninsured at diagnosis in the expansion states compared with nonexpansion states. We also found that the ACA policy adoption led to a reduction in the proportion of uninsured individuals with HIV-a-B-NHL in expansion states of 34.9%, compared with 15.9% in non-expansion-adopted states. There was a statistically significant improvement in the 2-year survival rate among patients with HIV-a-B-NHL in the expansion compared with nonexpansion states with the adoption of ACA (7.17% v 1.58%, P = .02).

Conclusion

Using a novel quasi-experimental model, we found that the ACA policy corresponded with a greater survival improvement in patients with HIV-a-B-NHL within Medicaid expansion-adopted states compared with nonexpansion states. We believe that this evidence should be taken into consideration in future policy making.

Full text links 

Read article at publisher's site: https://doi.org/10.1200/op.24.00354

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