Causal Effects of the Affordable Care Act (ACA) Implementation on Non-Hodgkin's Lymphoma Survival: A Difference-in-Differences Analysis

Introduction: Non -Hodgkin's Lymphoma (NHL) accounts for a substantial number of cancer cases in the United States, with a significant prevalence and mortality rate. The implementation of the Affordable Care Act (ACA) has the potential to impact cancer -specific survival among NHL patients by improving access to healthcare services and treatments. Objective: This study aims to assess the impact of the implementation of the ACA on cancer -specific survival among patients diagnosed with NHL. Methodology: In this retrospective analysis, we leveraged data from the Surveillance, Epidemiology, and End Results (SEER) registry to assess the impact of the ACA on cancer -specific survival among NHL patients. The study covered the years 2000-2020, divided into pre -ACA (2000-2013) and post -ACA (2017-2020) periods, with a three-year washout (2014-2016). Using a Difference -in -Differences approach, we compared Georgia (a non -expansion state) to New Jersey (an expansion state since 2014). We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities. Results: Among 74,762 patients, 56.2% were in New Jersey (42,005), while 43.8% were in Georgia (32,757). The pre -ACA period included 32,851 patients (51.7% in Georgia and 56.7% in New Jersey), and 27,447 patients were in the post -ACA period (48.3% in Georgia and 43.4% in New Jersey). The post -ACA period exhibited a 34% survival improvement (OR=0.66, 95% CI 0.58-0.75). ACA implementation was associated with a 16% survival boost among NHL patients in New Jersey (OR=0.84, 95% CI 0.74-0.95). Other factors linked to improved survival included surgery (OR=0.86, 95% CI 0.81-0.91), radiotherapy (OR=0.77, 95% CI 0.72-0.82), and married status (OR=0.67, 95% CI 0.64-0.71) . Conclusion: The study underscores the ACA's potential positive impact on cancer -specific survival among NHL patients, emphasizing the importance of healthcare policy interventions in improving patient outcomes.