Changes in the commercially insured cancer patient population following implementation of the Affordable Care Act in Washington state.

241 Background: The 2010 Patient Protection and Affordable Care Act (ACA) helped millions of uninsured Americans gain access to health insurance coverage through commercial insurance exchange programs. Little is known about how the composition of commercially insured cancer patients changed following implementation of the ACA. We conducted an analysis to understand how financial, neighborhood, and clinical characteristics of commercially insured cancer patients changed in Washington State following its implementation of ACA exchanges in 2014. Methods: We linked records for persons ages 18-64 with newly diagnosed lymphoma and solid tumors (excluding in situ) from the Western Washington SEER cancer registry between 2013 and 2018 to quarterly credit report data from TransUnion and enrollment records from Premera Blue Cross or Regence Blue Shield, the two largest insurers participating in the exchange in WA. Patients were required to have continuous enrollment 6 months prior to diagnosis to assess comorbidity. Adverse financial events (AFEs) were measured at the time of cancer diagnosis and categorized into severe (third-party collections, charge-offs), more severe (tax liens, delinquent mortgage payments), and most severe (foreclosure, repossession). We compared factors pre- and post-ACA (2013 v. 2018) and used multivariate logistic regression to investigate factors (age, sex, race/ethnicity, area deprivation index (ADI), stage, screenable cancer (breast, cervical, colorectal, lung), diagnosis year) associated with having any AFE at diagnosis. Results: 3878 cancer patients were included in the analysis: 2133 patients pre-ACA (2013) and 1745 patients post-ACA (2018). Post-ACA patients were more likely to be from non-Hispanic white populations and less likely to have an AFE at diagnosis (Table). In multivariate analysis, patients diagnosed in 2018 had a lower probability of having an AFE vs those diagnosed in 2013 (OR 0.53, CI 0.45-0.64). Conclusions: After the implementation of the ACA, the composition of patients in commercial plans was more racially and ethnically diverse. There was no change in stage at diagnosis or patients with screenable cancers, suggesting that the ACA did not impact screening-related cancer outcomes. Fewer commercially insured cancer patients were financially fragile at diagnosis. Future studies will compare cancer care outcomes and out-of-pocket spending pre- and post-ACA. Pre-ACA (2013)n=2133 Post-ACA (2018)n=1745 Age 18-44 47% 45% 55-64 53% 55% Sex Female 56% 57% Male 43% 43% Race/Ethnicity* Asian 6% 8% Black 2% 3% Hispanic 3% 4% White 88% 83% Other 2% 3% ADI Low (1-3) 53% 50% Mid (4-6) 30% 32% High (7-10) 17% 18% Comorbidity None 88% 88% 1 or more 12% 12% Stage Local 58% 59% Regional 23% 23% Distant 16% 16% Unknown 3% 2% Screenable Cancer Yes 62% <jats:td colspan="1" rowspan="1