PowerPoint Presentation OBJECTIVE Association of insurance coverage with diagnosis of malignant melanoma before and after the Affordable Care Act: a national database study • The Surveillance, Epidemiology, and End Results (SEER) cancer registry was analyzed for malignant melanoma between 2007 and 2015. • Standardized mean difference (2007-2013 vs 2014-2015) was used to compare insurance trends with sub-analysis for Medicaid expansion/non-expansion states • Survival was assessed via adjusted cox regression models. SYNOPSIS METHODS • To examine the impact of the ACA on insurance type (uninsured, Medicaid, non-Medicaid) and trends among patients diagnosed with malignant melanoma • To assess survival outcomes in patients diagnosed with malignant melanoma by insurance type CONCLUSION RESULTS • The ACA was intended, in part, to reduce the uninsured population • The ACA was fully implemented in 2014 with optional state Medicaid expansion and health insurance marketplaces • Prior studies show that insurance status affects cancer care, including prevention, diagnosis, stage at diagnosis, and management1 • The impact of the ACA on insurance trends of patients diagnosed with malignant melanoma is unknown • Nationally, the ACA decreased percentage of uninsured patients (-1.12% to -2.26%, P<0.05) and increased percentage of Medicaid enrollees (+1.53% to +4.02%, P<.005) diagnosed with malignant melanoma • Expansion states showed decreased percentage of uninsured patients (-1.43% to -2.24%, P<0.05) and increased percentage of Medicaid enrollees (+1.66% to +4.84%, P<0.05) • Non-expansion states showed no change in percentages of uninsured patients and Medicaid enrollees • All-cause and cause-specific mortality were decreased in uninsured and Medicaid patients diagnosed with melanoma compared to non-Medicaid insured patients (reference group). • The ACA decreased the rate of patients diagnosed with malignant melanoma with uninsured status, but this was only significant in Medicaid expansion states • However, Medicaid patients have worse all-cause and cause-specific mortality compared to non-Medicaid counterparts • We must address socioeconomic factors likely contributing these disparities through policy to ensure insurance coverage translates to quality care and survivorship REFERENCES 1. Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P, Siegel R, Stewart A, Jemal A. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008 Jan-Feb;58(1):9-31. Vignesh Ramachandran, MD1, Talha Ayaz, MD2, Asad Loya, MD3 1 Department of Dermatology, New York University, New York, NY 2 Department of Radiology, University of Texas Medical Branch, Galveston, TX 3 Department of Ophthalmology, Baylor College of Medicine, Houston, TX Figures 1, 2, 3: (1) national insurance trends in patients diagnosed with malignant melanoma; (2) sub-analysis of insurance trends in states which expanded Medicaid; (3) sub-analysis of insurance trends in non-expansion states 0 20 40 60 80 100 2007 2008 2009 2010 2011 2012 2013 2014 2015 In s u ra n c e R a te , % Year of Diagnosis Figure 2. Rates of Insurance Type in Expansion States Uninsured Any Medicaid Non-Medicaid Insurance 0 20 40 60 80 100 2007 2008 2009 2010 2011 2012 2013 2014 2015 In s u ra n c e R a te , % Year of Diagnosis Figure 1. Rates of Insurance Type in All States Uninsured Any Medicaid Non-Medicaid Insurance 0 20 40 60 80 100 2007 2008 2009 2010 2011 2012 2013 2014 2015 In s u ra n c e R a te , % Year of Diagnosis Figure 3. Rates of Insurance Type in Non-expansion States Uninsured Any Medicaid Non-Medicaid Insurance Figures 4, 5: (4) overall (all-cause) survival by insurance type and (2) cause-specific (melanoma-specific) survival by insurance type All authors have no financial conflicts of interest or disclosures