# Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform

> **NIH AHRQ R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2022 · $375,069

## Abstract

PROJECT SUMMARY/ABSTRACT
Cancer is among the most common causes of death and most costly diseases in the US, and timely access to
high quality treatment is essential for minimizing cancer morbidity and mortality. Insurance coverage is an
important determinant of access to care that contributes to documented disparities in outcomes. The
Affordable Care Act (ACA) expanded access to insurance for non-elderly adults through subsidized
Marketplace coverage and expansion of Medicaid to low-income adults in participating states. There is little
evidence regarding the impact of insurance coverage expansions on access to or quality of cancer care. The
proposed project will leverage variation in the timing of ACA provisions and changes in coverage under those
provisions across geographic areas to estimate the impacts of insurance coverage expansions on cancer
treatment. We use population-based data from Pennsylvania – the largest Medicaid expansion state that did
not have extensive coverage for low-income adults prior to the ACA. Data come from the Pennsylvania state-
wide cancer registry, along with data from all-payer inpatient, hospital outpatient, and ambulatory surgery
center administrative files from the Pennsylvania Health Care Cost Containment Council (PHC4), linked to the
registry at the individual level. The sample includes all non-elderly adult cancer patients in the state, with
discharge information across all payers, including for uninsured patients. We use a quasi-experimental
approach to estimate the effects of both private (Marketplace) and public (Medicaid) expansions on access to
and quality of care for patients diagnosed with the four most common cancers (breast, prostate, lung and
colorectal). Specifically, we examine the impact of insurance expansions on insurance coverage for cancer
patients (Aim 1), access to cancer treatment (Aim 2), and quality of cancer care (Aim 3). We hypothesize that
increases in coverage will be associated with shorter time from diagnosis to treatment; higher likelihood of
treatment in accredited cancer centers, academic centers, and high-volume hospitals; increased receipt of
guideline concordant care; and reductions in hospital readmission. All analysis will be stratified by cancer type,
allowing for assessment of differential impacts across cancers, and we will assess the role of insurance
coverage in reducing disparities in access for racial/ethnic minorities and rural populations. The project will
provide detailed evidence on how the ACA affected insurance coverage, access, and quality of care for cancer
patients, including the impact on existing disparities in care for underserved racial/ethnic minority and rural
patients. A detailed understanding of the impacts of health insurance coverage expansions on care for cancer
(among the most costly and deadly diseases in the US) will inform federal and state policymakers debating
health reform proposals, program officials seeking evidence to guide development ...

## Key facts

- **NIH application ID:** 10474355
- **Project number:** 5R01HS027396-03
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Lindsay Marie Sabik
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $375,069
- **Award type:** 5
- **Project period:** 2020-09-30 → 2024-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10474355

## Citation

> US National Institutes of Health, RePORTER application 10474355, Effects of Insurance Expansions on Cancer Treatment: Recent Policy Changes and Implications for Future Reform (5R01HS027396-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10474355. Licensed CC0.

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