Impact of the Affordable Care Act on Insurance Status of Patients Newly Diagnosed With Kaposi Sarcoma

Background: The Affordable Care Act (ACA) role in changing the insurance composition of patients diagnosed with many dermatological conditions, such as Kaposi Sarcoma (KS), has not been assessed. Methods: The Surveillance, Epidemiology and End Results (SEER) Program, which captures cancer data from nearly 40% of cases in the US was used to extract cases. Cases were subgrouped by Medicaid expansion and non-expansion states. Standard mean differences were used as the statistical measure with P-value <0.05 used for statistical significance. Results: 2,465 patients met the inclusion criteria. In patients newly diagnosed with Kaposi sarcoma nationally before and after ACA implementation, the analysis showed there was no significant difference in the percentage of uninsured patients, Medicaid-insured patients, or privately insured patients. Pre- and post-ACA sub-analysis of patients newly diagnosed with Kaposi sarcoma in states that expanded Medicaid showed: (1) significant decrease in the percentage of uninsured patients (-5.81% difference, 95% CI -9.58% to -2.04%, P <.05); (2) significant increase in the percentage of Medicaid-insured patients (+9.36% difference, 95% CI +0.35% to +18.37%, P <.05) and (3) no significant difference in the percent of privately insured patients (-3.54% difference, 95% CI -13.74% to +6.64%). Sub-analysis in non-expansion states showed no difference between the insurance subtypes. Conclusion: Medicaid expansion played the largest role in reducing the percentage of uninsured patients newly diagnosed with KS. In states without Medicaid expansion, it is important that public health forces ensure adequate access to medications with services like the Ryan White HIV/AIDS Program