Cost and transportation barrier trends related to Affordable Care Act among cancer survivors and atherosclerotic cardiovascular disease patients

Rabia Bega, Qaidar Alizai, Charalampos M Charalampous, Areesh Mevawalla, Meher Angez, Rida Ejaz, Lorenza Arena, Jethro Wang Zih-Shuo and Timothy M Pawlik

PLOS Global Public Health, 2026, vol. 6, issue 9, 1-15

Abstract: The Affordable Care Act (ACA) included major coverage expansions implemented in 2014. However, its association with cost‑related barriers among people with chronic disease remains incompletely described. We analyzed trends in cost and transportation related barriers to care between cancer survivors and adults with atherosclerotic cardiovascular disease (ASCVD) in relation to ACA implementation and expansion. National Health Interview Survey (NHIS) data from 2004-2024 for adults ≥18 years reporting a history of cancer or ASCVD without cancer were obtained. Primary outcomes were overall cost‑barrier and transportation barrier. We used survey weighted interrupted time series analysis (ITSA) with prespecified policy breakpoints and survey weighted modified Poisson regression to estimate associations between policy periods and barriers, adjusting for sociodemographic covariates. The analytic sample included 106,947 respondents: 63,505 cancer survivors and 43,442 adults with ASCVD without cancer. Overall cost barriers were reported by 8.1% of cancer survivors (n = 5,264) and 10.6% of adults with ASCVD without cancer (n = 4,772; p

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pgph00:0006791

DOI: 10.1371/journal.pgph.0006791

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