Mid-year insurance churn and loss of insurance coverage among U.S. cancer survivors before and after the COVID-19 pandemic: A nationwide analysis.
TL;DR
Insurance churn among cancer survivors is reported by as much as 1 in 4 CanS, and levels remain unchanged post COVID pandemic, and this disproportionately impacts racial minorities and economically vulnerable groups, and is associated with substantially higher healthcare spending.
Abstract
247 Background: Insurance continuity is a key determinant of access to cancer diagnostics, treatment initiation, and adherence. We evaluated rates of mid-year insurance churn and loss of insurance coverage, associated factors, and healthcare spending among U.S. cancer survivors (CanS) before (2019) and after (2022) the COVID pandemic. Methods: We identified adults aged >18 years with a self-reported cancer diagnosis (excluding non-melanoma skin cancers) in the 2019 and 2022 Medical Expenditure Panel Survey (MEPS). Monthly Insurance data allowed identification of individuals with ≥1 month mid-year loss of insurance, switching plans, or acquiring/losing secondary insurance, collectively labeled as churn. We calculated the mean per person annual healthcare spending by churn status and in demographic subgroups. Multivariable regression adjusted for age, race, income, insurance type, and spousal status identified factors associated with churn. Weighted analyses accounted for the complex survey design (p ≤ 0.05). Results: We identified U.S. CanS representing 20.8 million individuals in 2019 and 21.1 million in 2022. Insurance churn affected 28.6% of CanS in 2019 and 28% in 2022, compared with 21.7% and 21% of adults without cancer. Mid-year loss of insurance was reported by 6% CanS in both years. In 2019, the highest churn rates were among Black survivors -34% and CanS in the lowest income level -36%; in 2022, these rates were 39% and 41%, respectively. Women had lower odds of churn than men (2019 OR 0.54, p<0.001 vs 2022 OR 0.68, p=0.02). Younger survivors (18–45 years) had higher odds of churn compared with those ≥65 in 2019 (OR 1.83, p=0.05), but this age difference was no longer observed in 2022 (OR 0.92, p=0.81). In contrast, racial disparities emerged post-COVID: in 2022, Black (OR 1.73, p=0.01) and other-race survivors (OR 1.98, p=0.04) had significantly higher odds of churn compared with White survivors, while pre COVID this was not significant (p= NS). Annual healthcare spending were higher among CanS with churn ($16,648 vs $18,301) and increased post COVID ($17,487 vs $20,457). Post COVID White CanS who lost insurance mid-year had nearly double annual spending $17,893 vs $34,132 while black survivors had lower spending with a loss $17641 vs $6817. Conclusions: This study reports existing insurance churn among CanS and is especially important as we face changes to current federal subsidies. Insurance churn is reported by as much as 1 in 4 CanS, and levels remain unchanged post COVID pandemic. 6% cancer survivors lose insurance mid-year, and this disproportionately impacts racial minorities and economically vulnerable groups, and is associated with substantially higher healthcare spending. Understanding the factors that drive churn, including whether high spending precedes or results from coverage instability, will be essential for informing future policies.