Federal and state policies regulating short-term limited-duration insurance plans and timely cancer treatment initiation.
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BACKGROUND: The objective of this study was to examine the associations between federal and state short-term limited-duration (STLD) insurance plan regulations and timely cancer treatment initiation. METHODS: Adults aged 18-64 years newly diagnosed with female breast, colorectal, or non-small cell lung cancers in 2017-2019 were identified from the National Cancer Database. Patients were categorized into five groups on the basis of their state of residence at diagnosis: (1) the state continuously prohibited STLD plans; (2) the state stopped offering STLD plans after the 2018 federal rule; (3) the state kept the same 3-month limit on STLD plans before and after the 2018 federal rule; (4) the state expanded the sale of STLD plans but imposed more stringent regulation of STLD plans; and (5) the state expanded the sale of STLD plans and did not impose additional regulation. A difference-in-differences (DID) approach examined the changes in the percentages of patients initiating treatment within 30 days of their cancer diagnosis before and after the 2018 federal rule. RESULTS: For all cancers combined, compared to patients living in states continuously prohibiting STLD plans, a net decrease was observed in the percentages receiving timely treatment among patients living in states continuously limiting STLD plans to 3 months (DID, -1.61 percentage points [ppts]; 95% confidence interval [CI], -2.86 to -0.37 ppts), in states with less stringent regulations (DID, -2.09 ppts; 95% CI, -3.33 to -0.84 ppts), and in states with the least stringent regulations (DID, -2.48 ppts; 95% CI, -3.52 to -1.44 ppts). CONCLUSIONS: Limited or no state regulation of STLD plans after the 2018 federal expansion of plan coverage duration was associated with decreases in timely cancer treatment initiation.