Medicaid Expansion Associated with Narrowing Cancer Outcomes Disparities

July 23, 2020

A study of individuals in Ohio who were uninsured or had Medicaid insurance at the time of their cancer diagnosis suggested that Medicaid expansion is correlated with a narrowing of a critical cancer outcome disparity.

A study published in Cancer indicated that Medicaid expansion is associated with a narrowing of a critical cancer outcome disparity among adults from low-income communities.1

Given the findings of this study, researchers indicated that policymakers should evaluate the broad consequences of both implementing Medicaid expansion or limiting Medicaid expansion, including the impact these changes could have on cancer outcomes.

“Medicaid expansion under the [Affordable Care Act; ACA] decreased the number of uninsured individuals in the low-income population, and there have been several other population health benefits, including improving access to care, use patterns, and self-reported health outcomes,” the authors wrote. “The current study results suggested that Medicaid expansion also may have improved outcomes in patients with screening-amenable cancers.”

Using data from the Northeast Ohio Cancer Risk Assessment and Surveillance Engine (NEOCASE), researchers identified a total of 12,760 individuals aged 30 to 64 years who were diagnosed with incident invasive breast (female), cervical, colorectal, or lung cancer from 2011 through 2016 and who were uninsured or had Medicaid insurance at the time of their diagnosis. Notably, the sample was probability weighted based on income to reflect potential Medicaid eligibility under the ACA's Medicaid expansion.

Following adjustment for possible confounders, those who were diagnosed post-expansion were found to have 15% lower odds of having metastatic disease compared with those who were diagnosed pre-expansion (adjusted odds ratio, 0.85; 95% confidence interval [CI], 0.77-0.93). Moreover, a separate analysis that focused on individuals with private insurance who resided in high-income communities was conducted as a control, finding nonsignificant post-expansion (vs pre-expansion) changes in the outcome (adjusted odds ratio, 1.02; 95% CI, 0.96-1.09).

“The observed reduction in the odds of metastatic disease in the current study could be driven by an increase in the number of nonmetastatic cases (perhaps as a result of improved access to care), a decrease in the number of metastatic cases (perhaps as a result of improved uptake of preventive services), or a combination of the two. Any of these scenarios would be noteworthy, but a decrease in the number of metastatic cases would have the most proximate impact in reducing the total cancer morbidity and mortality burden,” the authors wrote. “As additional years of data become available, this trend should be examined further.”

In an editorial written by Hala T. Borno, MD, a genitourinary oncologist at the University of California San Francisco (UCSF), Tracy K. Lin, PhD, an assistant professor in the Institute for Health & Aging at UCSF, and Rajaie S. Batniji, DPhil, MD, a resident physician in internal medicine at Stanford, it was suggested that the current study findings may be due to a combination of limited cost sharing under the Medicaid plans and the expansions of the program.2 However, the authors indicated that regardless of these findings, improvements which expand healthcare access are still necessary.

“The current health insurance system in the United States allows for gaps in access and coverage and generates heterogenous cost-sharing models that lead to patient burden. Medicaid expansion under the ACA aimed to reduce the gap in access,” the editorial authors wrote.

“Nevertheless, expanding health care access is only a first step toward building a robust health care and health insurance system,” the editorial authors continued. “In addition to health care access for all, it is critical to ensure comprehensive coverage for all.”

References:

1. Kim U, Koroukian S, Statler A, Rose J. The Effect of Medicaid Expansion Among Adults From Low-Income Communities on Stage at Diagnosis in Those With Screening-Amenable Cancers. Cancer. doi: 10.1002/cncr.32895.

2. Borno HT, Lin TK, Batniji RS. Determining the Impact of Medicaid Expansion on Cancer Burden. Cancer. doi: 10.1002/cncr.33039.