Study: Changes in Health Insurance Coverage Can Harm Cancer Survivors

It's stressful to not have health insurance or to have it but not be able to afford to use it, known as being underinsured. Experts know both issues are linked with poorer cancer care and survival. In fact, it’s one of the strongest predictors of a poor outcome after cancer treatment. But few studies have looked at what happens when there is a disruption in health insurance coverage—for example, temporarily losing coverage because of a job change or a gain or loss of Medicaid eligibility. A new study found that these types of gaps in health insurance coverage can lead to limited access to treatment and reduced survival.

This study, published in the Journal of the National Cancer Institute (JNCI), reviewed 29 observational studies about health insurance coverage disruptions and cancer care in the US between 1980 and 2019. The reviewers found that compared to people whose insurance coverage was continuous, those with disruptions were less likely to receive cancer prevention, screening, and treatment. If they were diagnosed with cancer, they were:

• More likely to have an advanced disease at the time they were diagnosis
• Less likely to receive recommended treatment
• More likely to have worse survival

Of the studies reviewed, several also showed that these problems were more likely to happen the longer someone went without health insurance coverage. The findings were the same for multiple types of cancer, including breast, cervical, and colorectal cancers.

“With so many people losing jobs due to the COVID-19 crisis, we expect to see a large increase in families with health insurance coverage disruptions, because most people in the US get health insurance through their employers,” said Robin Yabroff, PhD, lead researcher on the study and senior scientific director of health services research at the American Cancer Society (ACS). “Unfortunately, this may also cause delayed or missed cancer screenings and fewer diagnoses at an early stage, which can also mean that treatment starts later.”

Health insurance coverage can reduce gaps or differences in care—called health disparities—and can help make sure everyone has the opportunity to be healthy, which is known as health equity. But disruptions in coverage are common among people with lower incomes and can happen when a person is in between jobs, if they move from one health care plan to another, or if their eligibility for Medicaid coverage changes. Because of this, expanding coverage options has been a focus of federal and state governments. One of the more recent studies found that people living in states that adopted Medicaid expansion under the Affordable Care Act, which provides health insurance to more people with lower incomes, had fewer coverage disruptions.

More research will be needed to account for recent policies and job trends, the authors noted. For instance, some state Medicaid programs have recently added work requirements, which may increase coverage disruptions if people lose their eligibility. And income fluctuations for “gig workers” like Uber and Lyft drivers, could affect their ability to have continuous health insurance coverage.