Fumiko Chino, MD, on Medicare’s Impact on Cancer Mortality Rates


In a recent interview with CancerNetwork, Fumiko Chino, MD, discussed the need to evaluate Medicare’s impact on cancer mortality rates, and moreover, what she and her colleagues found in a recent study presented at the 2020 ASCO Virtual Program.

According to data presented at the 2020 ASCO Virtual Program, states that expanded Medicaid coverage saw a steeper decline in cancer mortality rates, compared to those that didn’t follow the passage of the Affordable Care Act of 2010.

In a recent interview with CancerNetwork, Fumiko Chino, MD, discussed the need to evaluate Medicare’s impact on cancer mortality rates, and moreover, what she and her colleagues found.


I think that health and healthcare inequity has been a major issue in the United States. And part of that is driven by equal access to care and health insurance. The Affordable Care Act was specifically designed to try to improve these disparities through improving insurance status. And we know already that unfortunately, equal access to care can really be associated with poor quality of care, and ultimately survival.

So when we were putting together the study, we really were trying to figure out what the true benefit of the Affordable Care Act was, because there's been some evidence in the past that we've improved insurance status and that maybe patients are being diagnosed at an earlier stage, and maybe that the timeliness of the treatment is improving. But ultimately, what matters to most people is survival. So we wanted to show that the Affordable Care Act did have a meaningful impact on cancer survival.

We actually looked at a comprehensive national database, which included essentially everyone in the United States, all US residents who died from cancer, and we calculated age-adjusted cancer mortality for the entire US population but separated it into 2 groups: an expanded state cohort and a non-expanded state cohort. And we followed them over time. So not just in the peri-ACA years when Medicaid was being expanded, but also to establish their baselines.

What we found is that there really was a mortality difference between the 2 state cohorts and that unfortunately, there's been no cancer disparities. So basically, patients who live and expanded states, quite simply do better. And they did better even before the Affordable Care Act. But there was an additional cancer mortality benefit from states that expanded Medicaid and this is the first comprehensive national study to show this and I think that it's pretty impressive that we were able to show this in just a couple of years of follow up because I think as you know, it's not like you get diagnosed with cancer and then immediately you know, have a poor outcome. It really does take years, sometimes for a cancer diagnosis to ultimately, unfortunately kill people. So the fact that we were able to show it with just a couple of years of follow up is pretty phenomenal.

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