{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T06:02:49Z","timestamp":1772690569129,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T00:00:00Z","timestamp":1573430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K08CA228631"],"award-info":[{"award-number":["K08CA228631"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30AI064518"],"award-info":[{"award-number":["P30AI064518"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>To the authors' knowledge, little is known regarding the impact of the Patient Protection and Affordable Care Act (ACA) on people living with HIV and cancer (PLWHC), who have lower cancer treatment rates and worse cancer outcomes. To investigate this research gap, the authors examined the effects of the ACA on insurance coverage and receipt of cancer treatment among PLWHC in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>HIV\u2010infected individuals aged 18 to 64\u00a0years old\u00a0with cancer diagnosed between 2011 and 2015 were identified in the National Cancer Data Base. Health insurance coverage and cancer treatment receipt were compared before and after implementation of the ACA in non\u2013Medicaid expansion and Medicaid expansion states using difference\u2010in\u2010differences analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 4794 PLWHC analyzed, approximately 49% resided in nonexpansion states and were\u00a0more often uninsured (16.7% vs 4.2%), nonwhite (65.2% vs 60.2%), and of low income (36.3% vs 26.9%) compared with those in Medicaid expansion states. After 2014, the percentage of uninsured individuals decreased in expansion states (from 4.9% to 3%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01) and nonexpansion states (from 17.6% to 14.6%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.06), possibly due to increased Medicaid coverage in expansion states (from 36.9% to 39.2%) and increased private insurance coverage in nonexpansion states (from 29.5% to 34.7%). There was no significant difference in cancer treatment receipt noted between Medicaid expansion and nonexpansion states. However, the percentage of PLWHC treated at academic facilities increased significantly only in expansion states (from 40.2% to 46.7% [<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001]; difference\u2010in\u2010differences analysis: 7.2 percentage points [<jats:italic>P<\/jats:italic>\u00a0=\u00a0.02]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The implementation of the ACA was associated with improved insurance coverage among PLWHC. Lack of insurance still is common in non\u2013Medicaid expansion states. Patients with minority or low socioeconomic status more often resided in nonexpansion states, thereby highlighting the need for further insurance expansion.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32563","type":"journal-article","created":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T03:01:49Z","timestamp":1573441309000},"page":"559-566","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The impact of the Patient Protection and Affordable Care Act on insurance coverage and cancer\u2010directed treatment in HIV\u2010infected patients with cancer in the United States"],"prefix":"10.1002","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0314-6972","authenticated-orcid":false,"given":"Kelsey L.","family":"Corrigan","sequence":"first","affiliation":[{"name":"Duke University School of Medicine Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6990-3660","authenticated-orcid":false,"given":"Leticia","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Surveillance and Health Services Research Program American Cancer Society Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Robin","family":"Yabroff","sequence":"additional","affiliation":[{"name":"Surveillance and Health Services Research Program American Cancer Society Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun Chieh","family":"Lin","sequence":"additional","affiliation":[{"name":"Surveillance and Health Services Research Program American Cancer Society Atlanta Georgia"},{"name":"Department of Neurology University of Michigan Medical School Ann Arbor Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuesong","family":"Han","sequence":"additional","affiliation":[{"name":"Surveillance and Health Services Research Program American Cancer Society Atlanta Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3633-9685","authenticated-orcid":false,"given":"Junzo P.","family":"Chino","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine Durham North Carolina"},{"name":"Department of Radiation Oncology Duke Cancer Institute Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7142-7499","authenticated-orcid":false,"given":"Anna E.","family":"Coghill","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology Program H. 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