Childhood cancer survivor study participants' perceptions and understanding of the affordable care act

Elyse R. Park, Anne C. Kirchhoff, Giselle K. Perez, Wendy Leisenring, Joel S. Weissman, Karen Donelan, Ann C. Mertens, James D. Reschovsky, Gregory Armstrong, Leslie L. Robison, Mariel Franklin, Kelly A. Hyland, Lisa R. Diller, Christopher J. Recklitis, Karen A. Kuhlthau

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Abstract

Purpose: The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Methods: Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Results: Overall, 89.8% of survivors and 92.1% of siblings were insured. Many features of insurance coverage that survivors considered "very important" are addressed by the ACA, including increased availability of primary care (94.6%), no waiting period before coverage initiation (79.0%), and affordable premiums (88.1%). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as "very important" (P < .05 for all). Only 27.3% of survivors and 26.2% of siblings reported familiarity with the ACA (12.1% of uninsured v 29.0% of insured survivors; odds ratio, 2.86; 95% CI, 1.28 to 6.36). Only 21.3% of survivors and 18.9% of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Conclusion: Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits.

Original languageEnglish (US)
Pages (from-to)764-772
Number of pages9
JournalJournal of Clinical Oncology
Volume33
Issue number7
DOIs
StatePublished - Mar 1 2015

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Patient Protection and Affordable Care Act
Survivors
Neoplasms
Siblings
Preexisting Condition Coverage
Population Surveillance
Costs and Cost Analysis
Insurance Coverage
Quality of Health Care
Primary Care Physicians
Long-Term Care

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Park, E. R., Kirchhoff, A. C., Perez, G. K., Leisenring, W., Weissman, J. S., Donelan, K., ... Kuhlthau, K. A. (2015). Childhood cancer survivor study participants' perceptions and understanding of the affordable care act. Journal of Clinical Oncology, 33(7), 764-772. https://doi.org/10.1200/JCO.2014.58.0993

Childhood cancer survivor study participants' perceptions and understanding of the affordable care act. / Park, Elyse R.; Kirchhoff, Anne C.; Perez, Giselle K.; Leisenring, Wendy; Weissman, Joel S.; Donelan, Karen; Mertens, Ann C.; Reschovsky, James D.; Armstrong, Gregory; Robison, Leslie L.; Franklin, Mariel; Hyland, Kelly A.; Diller, Lisa R.; Recklitis, Christopher J.; Kuhlthau, Karen A.

In: Journal of Clinical Oncology, Vol. 33, No. 7, 01.03.2015, p. 764-772.

Research output: Contribution to journalArticle

Park, ER, Kirchhoff, AC, Perez, GK, Leisenring, W, Weissman, JS, Donelan, K, Mertens, AC, Reschovsky, JD, Armstrong, G, Robison, LL, Franklin, M, Hyland, KA, Diller, LR, Recklitis, CJ & Kuhlthau, KA 2015, 'Childhood cancer survivor study participants' perceptions and understanding of the affordable care act', Journal of Clinical Oncology, vol. 33, no. 7, pp. 764-772. https://doi.org/10.1200/JCO.2014.58.0993
Park, Elyse R. ; Kirchhoff, Anne C. ; Perez, Giselle K. ; Leisenring, Wendy ; Weissman, Joel S. ; Donelan, Karen ; Mertens, Ann C. ; Reschovsky, James D. ; Armstrong, Gregory ; Robison, Leslie L. ; Franklin, Mariel ; Hyland, Kelly A. ; Diller, Lisa R. ; Recklitis, Christopher J. ; Kuhlthau, Karen A. / Childhood cancer survivor study participants' perceptions and understanding of the affordable care act. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 7. pp. 764-772.
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abstract = "Purpose: The Patient Protection and Affordable Care Act (ACA) established provisions intended to increase access to affordable health insurance and thus increase access to medical care and long-term surveillance for populations with pre-existing conditions. However, childhood cancer survivors' coverage priorities and familiarity with the ACA are unknown. Methods: Between May 2011 and April 2012, we surveyed a randomly selected, age-stratified sample of 698 survivors and 210 siblings from the Childhood Cancer Survivor Study. Results: Overall, 89.8{\%} of survivors and 92.1{\%} of siblings were insured. Many features of insurance coverage that survivors considered {"}very important{"} are addressed by the ACA, including increased availability of primary care (94.6{\%}), no waiting period before coverage initiation (79.0{\%}), and affordable premiums (88.1{\%}). Survivors were more likely than siblings to deem primary care physician coverage and choice, protections from costs due to pre-existing conditions, and no start-up period as {"}very important{"} (P < .05 for all). Only 27.3{\%} of survivors and 26.2{\%} of siblings reported familiarity with the ACA (12.1{\%} of uninsured v 29.0{\%} of insured survivors; odds ratio, 2.86; 95{\%} CI, 1.28 to 6.36). Only 21.3{\%} of survivors and 18.9{\%} of siblings believed the ACA would make it more likely that they would get quality coverage. Survivors' and siblings' concerns about the ACA included increased costs, decreased access to and quality of care, and negative impact on employers and employees. Conclusion: Although survivors' coverage preferences match many ACA provisions, survivors, particularly uninsured survivors, were not familiar with the ACA. Education and assistance, perhaps through cancer survivor navigation, are critically needed to ensure that survivors access coverage and benefits.",
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