Abstract: PD06-07
Sources of Funding: Supported by a Research Scholar Grant RSGI-15-017-01 CPHPS from the American Cancer Society

Introduction

The Affordable Care Act (ACA) has increased insurance coverage most significantly among the working poor and childless adults previously ineligible for Medicaid. We report on a prospective cohort of low-income, uninsured men with prostate cancer (CaP) in their transition from a statewide CaP treatment and navigation program (IMPACT) to comprehensive health insurance under the ACA.

Methods

We engaged 25 men in semi-structured telephone interviews focusing on their initial experience transitioning from IMPACT to ACA-based insurance coverage. Interviews were recorded and transcribed for review. Transcripts were coded for themes around patient experience with IMPACT, the insurance enrollment process, and initial experience with comprehensive health insurance.

Results

Demographic and quality of life are summarized in Table 1. Four thematic domains were identified: 1) insurance enrollment process, 2) attributes and challenges of care in IMPACT, 3) attributes and challenges of care with ACA-based insurance, and 4) overall changes in care after insurance enrollment. Major findings are presented in Table 2. Twenty-three men enrolled in Medicaid. Fifteen men reported completing a paper application with 24% of patients receiving help from social workers and 20% from family members. Insurance coverage began more than 3 months after completing the application 40% of the time. Ten men reported that navigating CaP treatment was easier with IMPACT. Twelve patients reported improved access to care with insurance, while 6 patients reported increased health care costs and 5 reporting decreased health care costs after insurance enrollment. 24% of patients were able to keep the same primary doctor and urologist after enrollment.

Conclusions

Low-income men gaining insurance coverage under the ACA are predominantly enrolling in Medicaid. They face delays in coverage and interruptions in continuity of care, but report improved access. The relative burden of healthcare costs after gaining insurance is mixed.

Funding

Supported by a Research Scholar Grant RSGI-15-017-01 CPHPS from the American Cancer Society