New Study Reveals Impact of STLD Plans on Cancer Diagnosis Stages

Study Finds Increased Late-Stage Cancer Diagnoses in States With Fewer Insurance Regulations

A large-scale analysis of cancer diagnoses has revealed a disturbing correlation between the availability of limited-duration health insurance plans and an increase in late-stage cancer diagnoses. States that have fewer regulations regarding short-term limited-duration (STLD) insurance plans, which are designed to provide temporary coverage with limited benefits, show higher rates of late-stage cancer at diagnosis. This study emphasizes the critical impact state-level health insurance policies can have on early cancer detection and outcomes.

The research, which analyzed data from 1,289,366 adults diagnosed with cancer between 2016 and 2020, suggests that the relaxation of insurance policies regarding STLD plans has had a measurable negative impact on timely cancer diagnoses. The study, published in JAMA Network Open in March 2025, finds that states with relaxed or no regulations on STLD plans experienced a significant increase in late-stage cancer diagnoses compared to states with stricter regulations. This association underscores the complex interplay between insurance coverage, healthcare access, and cancer survival rates.

What Are Short-Term Limited-Duration Plans?

STLD plans are an alternative to standard health insurance and are typically used as temporary coverage during transitions, such as between jobs or for individuals who are temporarily uninsured. These plans, however, come with notable drawbacks: they tend to feature high deductibles, significant out-of-pocket costs, and limited coverage for essential services such as cancer screenings or diagnostic tests. Even when cancer screening is included in the plan, patients may face high costs for follow-up care related to cancer symptoms. This is a stark contrast to Affordable Care Act-compliant plans, which offer full coverage for cancer screenings and diagnostics without additional out-of-pocket costs.

STLD plans have drawn controversy due to their limited benefits, especially for individuals who may need continuous care for chronic conditions such as cancer. While these plans may seem like a cost-effective alternative for some, they often leave gaps in coverage that can result in delayed diagnoses, potentially making a diagnosis of cancer much more severe by the time it is discovered.

Methodology of the Study

To understand the impact of STLD plans on late-stage cancer diagnoses, the study included a cross-sectional analysis of 1,289,366 newly diagnosed cancer patients between 2016 and 2020. Researchers examined data from the National Cancer Database (NCDB), a comprehensive registry that includes cancer patients diagnosed in 47 states and the District of Columbia.

The participants were grouped based on the insurance policies of the states where they resided, specifically focusing on whether those states had additional regulations on STLD plans. States were categorized into four groups:

1. States that continuously prohibited STLD plans.
2. States that stopped allowing STLD plans after 2018.
3. States with some restrictions on STLD plans.
4. States with no additional STLD regulations.

Using a difference-in-differences methodology, the researchers compared the rates of late-stage cancer diagnoses before and after 2018 in these states. The results were adjusted for sociodemographic factors, diagnosis year, and state-level variations.

Key Findings of the Study

The study revealed alarming trends regarding late-stage cancer diagnoses in states with looser restrictions on STLD plans:

• States with no additional STLD regulations saw a 0.76 percentage point increase in late-stage cancer diagnoses compared to states that had continuously prohibited STLD plans.
• States with some STLD regulations experienced a 0.84 percentage point increase in late-stage diagnoses compared to those with continuous prohibition.
• In total, nearly half (46.9%) of the participants were from states with no additional STLD regulations, highlighting the significant number of people impacted by these policies.

The study also observed demographic variations among the state groups. For example, states that continuously prohibited STLD plans had the highest percentage of Hispanic and non-Hispanic Asian and Pacific Islander patients. These findings highlight the disparities in healthcare access and early cancer detection among different demographic groups in various states.

Implications of the Study

The findings of this study have significant implications for public health policy and cancer care in the United States. The data suggests that loosening restrictions on STLD plans can have serious consequences for individuals’ access to timely and affordable cancer care. Late-stage cancer diagnoses are associated with lower survival rates and more intensive treatment regimens, often resulting in higher medical costs and poorer quality of life for patients.

“This study provides compelling evidence that the 2018 federal policy change, which relaxed restrictions on STLD plans, has contributed to an increase in late-stage cancer diagnoses,” said Nuo Nova Yang, MSPH, Surveillance and Health Equity Science at the American Cancer Society, and lead author of the study. “Our findings reinforce the need for states to carefully consider the implications of STLD plan policies and ensure that they do not inadvertently delay cancer diagnoses and hinder access to appropriate care.”

The Bigger Picture: State Policies and Healthcare Access

The increase in late-stage diagnoses observed in this study is consistent with previous research showing that the availability of comprehensive health insurance, including full cancer screening coverage, plays a crucial role in early cancer detection. The study underscores the importance of state policies in shaping the healthcare environment and directly impacting the health outcomes of residents.

With states across the U.S. adopting a patchwork of insurance policies, it is more important than ever to advocate for policies that ensure equitable access to timely and effective cancer screenings. Federal efforts to strengthen and standardize insurance coverage can help mitigate the adverse effects of STLD plans and improve cancer survival rates nationwide.

Limitations of the Study

While the study provides valuable insights into the relationship between STLD plan availability and late-stage cancer diagnoses, there are some limitations to consider. The data used in the analysis is hospital-based, rather than population-based, which may limit the generalizability of the findings. Additionally, the study did not have access to information regarding the specific insurance plans of individual patients, making it difficult to directly identify those who were enrolled in STLD plans.

Furthermore, the study only analyzed newly diagnosed cancer patients aged 18-64 years, and the findings may not fully represent the experiences of older adults or those who are uninsured. The study also found relatively low coverage for melanoma in the NCDB, which may limit the applicability of the findings to certain cancer types.

Conclusion

The findings of this study highlight a critical issue in healthcare policy: the impact of limited-duration health insurance plans on the timely detection and treatment of cancer. States with reduced regulations on STLD plans have seen an increase in late-stage cancer diagnoses, potentially leading to poorer outcomes for patients. These findings underscore the need for more robust policies to ensure that all individuals have access to comprehensive health coverage that supports early cancer detection and intervention.

Learn more: https://jamanetwork.com/journals/ja...iclePDF&utm_content=jamanetworkopen.2025.1075