The 2010 Affordable Care Act expanded access to health insurance for many Americans. In a study presented at the American Society of Clinical Oncology (ASCO) 2019 Annual Meeting, Anna Jo Smith, MD, MPH, MSc, and Amanda Nickels Fader, MD, found that the Affordable Care Act led to earlier diagnosis and treatment of ovarian cancer. In this interview with i3 Health, Dr. Smith, a gynecology and obstetrics resident at Johns Hopkins Medicine, discusses the implications of her study's results.
What led you to explore the impact of the Affordable Care Act on early-stage ovarian cancer diagnosis and treatment?
Anna Jo Smith, MD, MPH, MSc: With ovarian cancer, early diagnosis and treatment help women to live longer and increase their likelihood of remission. Interventions that improve early diagnosis and treatment are critical to improving outcomes. We were interested in the possible impact of one intervention: the insurance expansions under the Affordable Care Act. Our previous research found gains in insurance coverage and improvements in stage at diagnosis for young women under the Affordable Care Act's dependent coverage mandate.
Can you comment on the significance of your latest study's results?
Dr. Smith: We found that women with ovarian cancer were diagnosed earlier and received treatment sooner under the Affordable Care Act. We used a difference-in-differences approach to assess for the significance of these trends, and our results showed a significant improvement in stage at diagnosis and timely treatment.
A difference-in-differences approach approximates a randomized controlled trial by comparing the trends in the intervention group (women ages 21 to 64, who were impacted by the Affordable Care Act) to the trends in the control group (women ages 65 and older, who were unlikely to be impacted by the Affordable Care Act) before and after the intervention. This approach controls for background differences and secular trends. We also controlled for multiple variables that impact insurance access, including patient race, living in a rural area, area-level household income and education level, Charlson comorbidity score, distance traveled for care, census region, and care at an academic center.
Do you think that the 2019 elimination of the Affordable Care Act's individual mandate penalty will impact the diagnosis and treatment of early-stage ovarian cancer?
Dr. Smith: We were not able to evaluate the impact of specific components of the Affordable Care Act. We remain concerned that any decreases in the Affordable Care Act's insurance expansions could impact women with ovarian cancer.
What are some key takeaways that you hope policymakers and the general public will gain from this study?
Dr. Smith: Detecting and treating ovarian cancer at an early stage saves lives and lowers health care costs compared with treatment of cancer at a more advanced, incurable stage. As a result of the insurance gains under the Affordable Care Act, women were more likely to be diagnosed at an earlier stage and experience fewer delays in treatment. Women with public insurance experienced even larger gains in early-stage diagnosis and earlier receipt of treatment.
About Dr. Smith
Anna Jo Smith, MD, MPH, MSc, is a gynecology and obstetrics resident at Johns Hopkins Medicine. A recipient of the Marshall Scholarship, she completed her graduate training in public health at the London School of Hygiene and Tropical Medicine and the London School of Economics. Her research focuses on the impact of public policy on women's health outcomes.
For More Information
Smith AJ & Nickels A (2019). Impact of the Affordable Care Act on early-stage diagnosis and treatment for women with ovarian cancer. J Clin Oncol (ASCO Annual Meeting Abstracts), 37(suppl_18). Abstract LBA5563. DOI:10.1200/JCO.2019.37.18_suppl.LBA5563
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent those of i3 Health.