To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer.
We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I–II vs III–IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21–26 years vs women aged 27–35 years. We used the National Cancer Database with the 2004–2009 surveys as the pre-ACA years and the 2011–2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level.
A total of 1,912 gynecologic cancer cases pre-ACA and 2,059 post-ACA were identified for women aged 21–26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27–35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI −4.0 to 0.1, P=.04) for young women aged 21–26 years vs women aged 27–35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4–6.9, P=.03) for women aged 21–26 years. Receipt of fertility-sparing treatment increased for women in both age groups post-ACA (P for trend=.004 for women aged 21–26 years and .001 for women aged 27–35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001).
Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.