2026 ACRLP Proceedings: From Law to Life

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This content is from UT Health San Antonio’s book, “Advancing Cancer Research for Latinos and All Populations: 2026 Conference Proceedings,” which highlights results of the same-named conference in February 2026.

Effects of the Affordable Care Act on Cancer Care and Outcomes

Dr. Xuesong Han is Scientific Director of Health Services Research at the American Cancer Society.

History of the Affordable Care Act

Dr. Han’s research focuses on how health policies like the Affordable Care Act (ACA) affect access to care and cancer outcomes. The ACA was signed into law in March of 2010 and is the largest healthcare system change in the US since the establishment of the Medicare and Medicaid programs. Its goals are to improve health insurance coverage, quality of care, and patient outcomes, and to maintain or lower costs by catalyzing change in the healthcare delivery system. Last year, Congress passed legislation that included large funding cuts and the addition of work requirements to Medicaid programs. Furthermore, enhanced premium tax credits for ACA marketplace plans have officially expired. These policy changes threaten to reverse more than a decade of progress under the ACA, such as the expansion of insurance coverage.

Insurance coverage is essential for access to care in the US, and especially important for the Latino population given the structural barriers to obtaining employer sponsored insurance and historically high uninsured rates. In 2010, before most of the ACA’s major provisions were implemented, Latinos had the highest uninsured rate, with nearly 1 in 3 lacking health insurance coverage. By 2015, the uninsured rate among Latinos had dropped to approximately 1 in 5.

Extensive evidence has shown that insurance coverage is a strong determinant of care and outcomes across the cancer care continuum, improving access to preventive service, increasing cancer screening rates, enabling earlier stage at diagnosis, enhancing receipt of treatment, increasing clinical trial participation, improving medication adherence, reducing financial hardship, and increasing quality of life and survivorship. Clearly, the ACA has the potential for far reaching effects throughout the cancer control continuum, affecting cancer care delivery through 3 main mechanisms: health insurance expansion, health insurance coverage reform, and payment and delivery system reform.

Effects of the ACA on cancer care

The ACA impacts cancer care and outcomes through many mechanisms, including dependent coverage expansion, elimination of cost sharing for preventive services, and Medicaid expansion. Dependent coverage expansion allows young adults to stay on their parents’ health insurance plan until they turn 26. One study by Dr. Han and colleagues focused on young women newly diagnosed with cervical cancer in the National Cancer Database. This study found that ACA dependent coverage expansion provision was associated with a net increase of 7.6% in early-stage diagnosis and a net increase of 13.4% in receipt of fertility sparing treatment.

Another study analyzed the elimination of cost sharing for preventive services. This provision requires insurers to cover preventive services recommended by the US Preventive Services Task Force with no deductible or co-pay. The provision was shown to be associated with increased rates of colorectal screening, especially among low-income adults and adults with low educational attainment.

A comparison of expansion and non-expansion states

Studies have also compared insurance coverage rates, access to care, and cancer outcomes in states that implemented Medicaid expansion versus states that did not. Decreases in uninsured rates among newly diagnosed cancer patients aged 18 to 64 years were observed in both Medicaid expansion and non-expansion states, indicating a positive overall effect for all states. However, the largest decrease in uninsured rates were among low-income patients in Medicaid expansion states. In fact, differences in insurance coverage based on poverty and rurality were nearly eliminated among newly diagnosed cancer patients in Medicaid expansion states, while these differences remained in non-expansion states.

Medicaid expansion was also associated with a net increase in 2-year survival. Liver cancer patients in expansion states, for example, had better survival than those in non-expansion states, although the ACA seemed to trigger improvements in survival in both expansion and non-expansion states. Medicaid expansion was also associated with an increased receipt of palliative care as part of the first-course treatment among individuals diagnosed with advanced-stage cancer. A large drop in reporting medical financial hardship was also observed among low-income cancer survivors residing in expansion states. Finally, Medicaid expansion states showed a smaller impact on early-stage cancer diagnosis by the COVID-19 pandemic.

Overall, research by Dr. Han and colleagues has shown convincing evidence that the ACA has led to improvements in cancer care and outcomes across the cancer continuum, including increased health insurance coverage, increased cancer screening services, earlier stage at diagnosis, improved access to timely treatment, improved cancer survival, reduced cost of care, reduced health disparities, and increased protection during the COVID-19 pandemic. However, more research is needed to evaluate ACA effects among racial and ethnic minorities, socioeconomically disadvantaged groups, and medically underserved populations. More work is also needed to further characterize outcomes in non-expansion states, to understand the benefits of the ACA on populations not considered primary beneficiaries, and to analyze ongoing policy threats to the ACA.

Bringing Cancer Prevention, Screening & Survivorship to Primary Care

Dr. Ramon S. Cancino is Professor in the Department of Family & Community Medicine at UT San Antonio and Executive Director of the Primary Care Center at UT Health San Antonio.

Cancer prevention in the primary care setting

The core premise of Dr. Cancino’s presentation was that primary care is where cancer prevention becomes realized. Latino populations in the US exhibit persistently lower screening rates than non-Hispanic White populations. Screening and prevention efforts must be rooted in primary care. Whereas policy changes may expand access to cancer care, that access is operationalized in the primary care setting. Primary care is defined as the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.

Collaboration between research and primary care

In recognition of this need, the Mays Cancer Center and primary care physicians at UT Health San Antonio developed a joint prevention and screening committee that includes both clinicians and researchers. In addition, Dr. Cancino’s work has led to the development of redesigned workflows at 8 academic primary care sites to focus on care delivery to patients with Medicaid insurance, low-income patients, and uninsured patients. As part of this work, improved rates of cervical and colorectal cancer screening were observed.

With the support of American Cancer Society, a multidisciplinary team was also formed to align processes around patients at high risk for lung cancer and in need of lung cancer screening. Over 4 years, an infrastructure was developed to collect data, screen patients, and improve patient navigation. This initiative resulted in an increase in screening rate to nearly 40%, almost twice the national average and 3 times the Texas average for lung cancer screening. These gains were not associated with new guidelines, staff members, or clinicians, but were the result of aligning sustainable processes across primary care to target a cancer screening intervention.

Structural barriers account for 70% to 90% of cancer screening hesitancy. Dr. Cancino and colleagues developed a clinical trial utilizing community health workers to navigate male patients who lived in areas of persistent poverty to colorectal cancer screening, to explain the benefits of screening, to assess non-medical drivers of health, and to help direct patients to local resources. Initial analysis of this research shows that 81% of male patients in the intervention group received a colorectal cancer screening compared with 11% in the usual care group.

Primary care and improved cancer outcomes

A diagnosis of cancer does not suspend other chronic health conditions such as diabetes and hypertension. Work by Dr. Cancino and colleagues has shown that patients treated in the Mays Cancer Center who did not see a primary care physician during cancer treatment had worse outcomes than patients who did. Patients who did not see a primary care physician had more emergency room visits, worse blood pressure control, and worse diabetes control. As a response to this finding, the Mays Cancer Center and UT Health Primary Care Center partnered to develop the Medical Management Program, which allows for the provision of primary care services for patients during active cancer treatment and matches patients with a primary care physician when active cancer treatment concludes.

Patient advocacy is another important aspect of cancer intervention. This includes advocacy to enhance access to primary care, ensure common-sense metrics, and incentivize the healthcare system to provide patient care. Policy should be aligned with desired outcomes and operational design, and cancer prevention should be embedded in every primary care practice. Furthermore, focus for funding initiatives should include increased funding for infrastructure, not just increased awareness.

Cancer prevention must be integrated with primary care, and primary care must remain a priority throughout the cancer care experience. Indeed, the futures of oncology and primary care must be structurally aligned. Cancer prevention interventions that are integrated within the primary care setting have immense potential for achieving sustained, improved, and cost-effective outcomes.

Access to Healthcare & Cancer Patients

Dr. Elena Rios is president of the National Hispanic Health Foundation.

Disruptions to the healthcare system in the US

Dr. Rios’s presentation began by discussing the disruption of the healthcare system by recent federal policy changes. Over the past few years, there has been a $1 trillion cut to Medicaid funding, which will result in an estimated 20 million uninsured individuals, with an 80 hour/month work requirement to reapply. The Affordable Care Act (ACA) tax credits have also been cut, which will cause premiums to double according to the Center on Budget and Policy Priorities, resulting in another 3.8 million uninsured per year from 2026 to 2034.

Declining enrollment and worsening risk pools will force future higher premiums, and there will be an estimated $7.7 billion increase in the demand for uncompensated care in 2026, resulting in less continuity of care and provider sustainability. Beyond 2027, there is expected to be a greater shift of uninsured individuals into employer-sponsored coverage as they seek new employment with health coverage. Even the Medicare Advantage program has seen the lowest enrollment rate raise in years.

The current administration’s policies are focused on lowering prescription drug prices for all Americans by codifying the Most-Favored-Nation policy. While this policy is often described as an easy solution for affordability, many of the countries used as benchmarks restrict access to medicines through price controls and have a different healthcare system than the US. Under this policy, local providers may be unable to stock medicines due to price controls and patients may be forced to travel farther for care. Other initiatives of the Most-Favored-Nation policy are the direct transfer of funds to individuals and families to purchase insurance and personal health savings accounts, and a cost-sharing reduction program for healthcare plans.

Recent losses of research funding

The current administration also proposed $2.7 billion in funding cuts from the National Cancer Institute in the first quarter of 2025. Other proposed funding cuts include a cap on indirect costs for the National Institutes of Health (NIH) grants, a temporary halt on agency programs and personnel, and the elimination of fairness initiatives. These cuts will negatively impact cancer institutions, academic health centers, cancer researchers, and ultimately the health of cancer patients.

As a result of funding cuts, 30 NIH clinical trials have been interrupted, affecting over 74,000 cancer patients. Cuts have also led to a shortage of nurses, the loss of treatment for patients in rural areas, and postponed drug approvals. Approximately 1800 grants have also been terminated, resulting in the termination of student salaries and stipends, and a decrease in PhD programs.

Policies with a positive impact

Some policies may be able to make a positive impact on the healthcare landscape. The LEAP Act is a bipartisan effort to ensure graduate students have a borrowing capacity equal to their professional peers. This will expand the pipeline for critical health professionals, support rural and overlooked populations, and improve cultural competence in healthcare. The policy will also reduce financial barriers for students, enabling the completion of graduate and professional degrees, and opening more careers to Americans from varied backgrounds.

Another bill moving through Congress is the Dignity Act, which aims to keep families together and protect citizens in light of recent actions taken by immigration enforcement. Since 60% of non-citizen spouses are primary caregivers, this bill allows non-citizens to obtain regulatory status, excluding individuals with a criminal history or who are a security risk. This bill would reduce the strain on caregivers who are critical to patient care, and support underserved locations and workforce staff.

The Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act was included in a recently passed appropriations law which allows Multi-Cancer Early Detection (MCED) screenings and establishes a clear pathway for Medicare to cover FDA-approved blood-based tests that can detect multiple cancers early. The Act includes the Mikaela Naylon Give Kids a Chance Act and reauthorizes the Childhood Cancer STAR Act, boosting research into rare pediatric diseases. The legislation also enacts major reforms to Pharmacy Benefit Managers (PBMs) in Medicare Part D, addressing opaque practices that have increased costs for cancer drugs, and extends Acute Hospital Care at Home (AHCAH) waivers through September 30, 2030, which allows for, among other things, remote cancer care.

Congress has also increased funding for the National Cancer Institute (NCI) in 2026 compared to 2025, and funding levels are trending upwards for Congress to fully fund cancer research. This is a result of advocacy efforts, which are key to initiating and propelling legislative initiatives through Congress and enabling policy changes that make a real difference for everyday people. Policy efforts must focus on the restoration of funding for research and increasing healthcare coverage for all residents of the US.

SEE THE FULL CONFERENCE PROCEEDINGS