TABLE 1.

Treatment and Comparison Groups Defined by Income and State Policy

Eligibility Category	Description	Possible Mechanism for ACA Coverage Effect
Pre-ACA Medicaid eligible	Adults eligible for Medicaid before ACA Medicaid expansion. Eligibility commonly limited to adults with disabilities, low-income seniors, pregnant women, and some low-income adults with dependent children. Upper income limits in many states extremely low. Several states undertook early expansions (2010–2012)	Increased awareness of Medicaid and simplified application process may increase applications and enrollment. Individual coverage mandate should increase effort to enroll, but many individuals eligible for Medicaid pre-ACA would be exempt from any penalty
Expanded Medicaid eligible	Adults newly eligible for Medicaid, up to 138% FPG in expansion states	New zero or low-cost coverage; expect larger effect for cancer survivors.22,25 Individual mandate would increase takeup for adults in this category, but the effect would be similar for adults with and without a cancer history
Poor adults, not Medicated eligible	Adults with income <100% FPG, not Medicaid-eligible pre-ACA and residing in nonexpansion states. Not eligible for Marketplace premium subsidies	Small indirect benefits. May experience increased offers of coverage through employers, or may purchase unsubsidized Marketplace plans. Latter effect may be greater for cancer survivors. Adults who fall in this category are exempt from the individual mandate
Marketplace premium subsidies	Adults eligible for premium subsidies for purchase of private plans. In Medicaid expansion states, from 138% to 400% FPG; in states not expanding Medicaid, from 100% to 400% FPG	Newly available subsidized private insurance without healthrelated underwriting. Cancer survivors expected to have higher demand for coverage22,25
Alternative affordable coverage	Adults who are income eligible for Marketplace premium subsidies, but with employment-sponsored insurance offers or coverage, or Medicare enrolled	Small indirect benefits. Individual mandate may encourage takeup of employer-sponsored insurance offers, or purchase of unsubsidized Marketplace plans. Both effects expected to be greater for cancer survivors22,25
Income >400% FPG	Adults not eligible for Marketplace subsidies.	Individual mandate may encourage purchase of unsubsidized Marketplace plans. Effect may be slightly larger for cancer survivors, who benefit from reduced medical underwriting

ACA indicates Affordable Care Act; FPG, federal poverty guideline.