# Disparities in Financial and Clinical Outcomes among Commercially-Insured Cancer Patients following the Affordable Care Act

> **NIH NIH R01** · FRED HUTCHINSON CANCER CENTER · 2024 · $402,600

## Abstract

Project Summary/Abstract
Demographic changes in the commercially insured population following implementation of the Affordable Care
Act (ACA)—specifically improved enrollment of the near-poor and those with chronic comorbidities--may have
paradoxically magnified the problem of “underinsurance;” that is, insurance that leaves persons at high risk for
financial hardship and care gaps following illness. The central objective for this study is to understand the
extent to which commercially insured cancer patients--particularly the near-poor and those with chronic
conditions—are at risk for shortfalls in care and adverse financial outcomes. Our working hypothesis is that
underinsurance is causing gaps in care and financial hardship for a substantial proportion of vulnerable cancer
patients with commercial insurance in the post-ACA era. To address our objective and hypothesis, we will
utilize a novel person-linked, population-level database that includes: 1) Western WA SEER cancer registry
data for cancer patients diagnosed in 2009-2022; 2) WA state voter registration file data (non-cancer controls);
3) Enrollment and claims records from the state's largest commercial payers (Regence Blue Shield and
Premera Blue Cross); 4) Longitudinal financial and credit records from TransUnion; 5) Washington State
bankruptcy records and 6) Medicaid enrollment records. Using this unique database that is updated annually,
our first aim is to understand how the neighborhood characteristics, financial health, and clinical characteristics
of commercially insured cancer patients have changed following ACA implementation. Due to expanded
eligibility for commercial insurance under the ACA, we hypothesize that a greater proportion of cancer patients
diagnosed post-ACA (2015-2022) live in socioeconomically disadvantaged neighborhoods, are financially
fragile (lower credit, higher debt, delinquent payments), and have more comorbidities than pre-ACA (2009-
2012) patients. Our second aim is to estimate post-ACA trends in out-of-pocket (OOP) cost exposure and
underinsurance, with emphasis on vulnerable populations. We will characterize trends and variability in OOP
exposure and risk of underinsurance for cancer patients across employer-based and ACA marketplace plans.
Our third aim is to determine the extent to which commercially insured, vulnerable cancer patients diagnosed
after implementation of the ACA experience disparities in care and outcomes compared to less vulnerable
patients. In addition, we will measure the relationship between OOP cost exposure and adverse outcomes for
each population, defined as gaps in quality of care, financial hardship, and disenrollment from commercial
insurance and/or enrollment in Medicaid following diagnosis. This unique study and ongoing collaboration with
an external, community-based multi-stakeholder advisory group will provide crucial evidence to inform clinical
and policy discussions aimed at identifying and reducing disparities in treat...

## Key facts

- **NIH application ID:** 10804123
- **Project number:** 1R01CA274541-01A1
- **Recipient organization:** FRED HUTCHINSON CANCER CENTER
- **Principal Investigator:** SCOTT D. RAMSEY
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $402,600
- **Award type:** 1
- **Project period:** 2024-07-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10804123

## Citation

> US National Institutes of Health, RePORTER application 10804123, Disparities in Financial and Clinical Outcomes among Commercially-Insured Cancer Patients following the Affordable Care Act (1R01CA274541-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10804123. Licensed CC0.

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