Persistent Financial Burden Among U.S. Cancer Survivors Despite Affordable Care Act Implementation: Implications for Survivorship Financial Education

Cancer is a leading cause of morbidity and mortality in the U.S., with significant financial implications for patients, especially those with limited access to resources. Particularly, the rising costs of cancer treatment have placed considerable strain on cancer survivors. This study evaluates the impact of the Affordable Care Act (ACA) on healthcare costs for cancer survivors. Using data from the Medical Expenditure Panel Survey (2010–2019), we analyzed data for 9,041 U.S. adult cancer survivors aged 18–64. ACA implementation (post- vs. pre-ACA period) was the primary exposure. We examined changes in out-of-pocket (OOP) healthcare spending and its proportion to total healthcare spending and family income of cancer survivors. Our findings indicate that post-ACA, mean OOP spending decreased significantly across various income groups: by 48.3% (95% CI, − 77.0 to − 19.6; P < .05) for the lowest-income, 51.5% (95% CI, − 82.6 to − 20.3; P < .05) for the low-income, and 17.2% (95% CI, − 32.8 to − 1.6; P < .05) for higher-income groups. On average, OOP spending decreased by 25.3% (95% CI, − 37.9 to − 12.6; P < .05) post-ACA. Post-ACA periods were associated with significant reductions in out-of-pocket spending among cancer survivors; however, out-of-pocket burden relative to income did not improve, indicating persistent financial vulnerability. These findings suggest that coverage expansion alone may be insufficient to ensure financial protection and underscore the importance of integrating survivorship-focused financial education, including insurance literacy, cost-sharing expectations, and structured cost-of-care communication into survivorship care planning and patient-facing educational resources.