Health insurance has been a well-known factor in influencing patient outcomes in the United States. The Patient Protection and Affordable Care Act, enacted in 2010, worked to help address insurance-related disparities. This chapter aims to examine the associations between cancer care and outcomes with insurance and insurance-relevant policies using the National Cancer Database (NCDB). We systematically reviewed published literature that used the NCDB to examine the association between insurance status or the Affordable Care Act (ACA) on cancer outcomes, defined as stage at diagnosis, time to treatment, type of treatment, survival outcome, readmission rates, treatment refusal, and treatment length. PubMed was used to identify relevant articles from 2007 to 2023. The search query included insurance coverage, medically uninsured, Medicaid, affordable care act, patient protection and affordable care act, national cancer database, and NCDB. Of the 176 identified studies, the most frequently studied associations with insurance status or the ACA were the type of treatment received (50.6%), survival outcome (38.6%), and the stage of disease at diagnosis (32.9%). Of the 176 studies, 134 examined the association between insurance status and cancer outcome. The most frequently examined variables were the type of treatment received (52.2%), survival outcome (41.0%), and the stage at diagnosis (23.1%). Of the 176 studies identified, 48 examined the effects of the Affordable Care Act and Medicaid expansion on cancer outcomes (other effects of the ACA were not examined). The majority of these studies focused on the stage at diagnosis (58.3%) and the type of treatment (47.9%). There is growing evidence that due to the Affordable Care Act, coverage has increased, and Americans with cancer are diagnosed at an earlier stage. However, other outcomes such as treatment length, readmission rates, and treatment refusals were present in few articles examined in this chapter.