James Douglas Thornton

The Affordable Care Act (ACA) significantly reduced uninsured individuals and improved financial protection; however, escalating cancer treatment has led to substantial out-of-pocket expenses, causing severe financial and mental health distress for individuals with cancer. Mixed evidence on the ACA's ongoing impact highlights the necessity of assessing health spending changes across income groups for informed policy interventions. In our nationally representative survey evaluating the early-and-long-term effects of the ACA on non-elderly adult cancer patients, we categorized individuals-based income subgroups defined by the ACA for eligibility. We found that ACA implementation increased insurance coverage, particularly evident post-2 years. Early post-ACA, there were declines in out-of-pocket spending for the lowest and low-income groups by 26.52% and 38.31% respectively, persisting long-term only for the lowest-income group. High-income groups experienced continuously increased out-of-pocket and premium spending by 25.39% and 34.28% respectively, with a notable 122% increase in the risk of high-burden spending. This study provides robust evidence of income-based disparities in financial burden for cancer care, emphasizing the need for healthcare policies promoting equitable care and addressing spending disparities across income brackets.