Federal and state policies regulating short-term limited-duration insurance plans and timely cancer treatment initiation.

Abstract

The objective of this study was to examine the associations between federal and state short-term limited-duration (STLD) insurance plan regulations and timely cancer treatment initiation. Adults aged 18-64 years newly diagnosed with female breast, colorectal, or non-small cell lung cancers in 2017-2019 were identified from the National Cancer Database. Patients were categorized into five groups on the basis of their state of residence at diagnosis: (1) the state continuously prohibited STLD plans; (2) the state stopped offering STLD plans after the 2018 federal rule; (3) the state kept the same 3-month limit on STLD plans before and after the 2018 federal rule; (4) the state expanded the sale of STLD plans but imposed more stringent regulation of STLD plans; and (5) the state expanded the sale of STLD plans and did not impose additional regulation. A difference-in-differences (DID) approach examined the changes in the percentages of patients initiating treatment within 30 days of their cancer diagnosis before and after the 2018 federal rule. For all cancers combined, compared to patients living in states continuously prohibiting STLD plans, a net decrease was observed in the percentages receiving timely treatment among patients living in states continuously limiting STLD plans to 3 months (DID, -1.61 percentage points [ppts]; 95% confidence interval [CI], -2.86 to -0.37 ppts), in states with less stringent regulations (DID, -2.09 ppts; 95% CI, -3.33 to -0.84 ppts), and in states with the least stringent regulations (DID, -2.48 ppts; 95% CI, -3.52 to -1.44 ppts). Limited or no state regulation of STLD plans after the 2018 federal expansion of plan coverage duration was associated with decreases in timely cancer treatment initiation.