Insurance coverage has at times been insufficient among patients with head and neck squamous cell cancer (HNSCC) on diagnosis, but access to health care for these patients expanded with the Patient Protection and Affordable Care Act (ACA), a study published in JAMA Otolaryngology-Head & Neck Surgery has shown.

In this prospective study, the researchers collected data on access to care, insurance coverage, and survival rates for patients with new HNSCC diagnoses (n=89,038) between January 2007 and December 2014 from the Surveillance, Epidemiology, and End Results database.

Although data on survival rates since ACA implementation were not directly accessible, the authors noted that from 2007 to 2013, 5-year survival was lower for uninsured patients than for insured patients. Overall 5-year survival during that period was 48.5% for uninsured patients vs 62.5% for patients with coverage, and HNSCC-specific 5-year survival was 56.6% for uninsured patients vs 72.2% for those with coverage during those years.

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During the study period, private insurance enrollment for patients with HNSCC increased from 79.0% before ACA implementation to 80.7% after implementation. Rates of Medicaid enrollment among these patients increased from 14.8% before ACA implementation to 16.2% after. The uninsured rate went down substantially with ACA implementation, from 6.2% to 3.0%.

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Changes in coverage rates were attributed only to states that underwent Medicaid expansion in 2014.

Insurance coverage is associated with improved survival outcomes and expanded for patients with HNSCC in states where Medicaid expansion occurred with implementation of the ACA.


  1. Cannon RB, Shepherd HM, McCrary H, et al. Association of the Patient Protection and Affordable Care Act with insurance coverage for head and neck cancer in the SEER database [published online September 13, 2018]. JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2018.1792