Quality of Cancer Care in California After Full Implementation of the Affordable Care Act: Findings From a Population-Based Study.

Abstract

Although previous studies investigated the impact of the Affordable Care Act on insurance coverage, cancer screening, and mortality, its impact on cancer care quality is understudied. This study examined receipt of guideline-concordant care by health insurance type after Affordable Care Act implementation. A cohort of 218,436 individuals aged 20-64 years with cancers of the breast, colon, endometrium, stomach, lung, and ovary between 2014 and 2021 was identified in the California Cancer Registry. Guideline-concordant care was defined by Commission on Cancer quality measures. Insurance was categorized as private, Medicaid, Medicare, other public, and uninsured. Logistic regression models assessed the associations between insurance type and receipt of guideline-concordant care, adjusting for sex, race, ethnicity, neighborhood SES, comorbidity, and reporting region. Analyses were conducted in 2025. Individuals with Medicaid or Medicare insurance had 23%-54% lower odds of having guideline-concordant radiation, chemotherapy, and surgery for breast and colon cancer than privately insured individuals. Individuals with Medicaid were less likely to have guideline-concordant chemotherapy for lung cancer (OR=0.63, 95% CI=0.44, 0.89) than those with private insurance. Individuals with Medicare insurance were less likely to have recommended lung cancer surgery and pathological examination than those who were privately insured (OR=0.76, 95% CI=0.60, 0.96). Substantial disparities in cancer care quality by insurance type exist in the post-Affordable Care Act era in California. More research on the individual and structural factors that may explain the observed differences is needed.