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Effects of the Affordable Care Act on Young Women With Gynecologic Cancers

Smith, Anna Jo, Bodurtha, MD, MPH; Fader, Amanda, N., MD

doi: 10.1097/AOG.0000000000002592
Contents: Gynecologic Oncology: Original Research

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

Under the Affordable Care Act's dependent coverage mandate, young women with gynecologic cancer are more likely to be insured and diagnosed at an early stage.

Department of Gynecology and Obstetrics and the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland.

Corresponding author: Anna Jo Bodurtha Smith, MD, MPH, Phipps 279, 600 N Wolfe Street, Baltimore, MD 21287-1281; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.