Medicaid Restrictions Negatively Impact Poor Breast Cancer Patients

Limiting Medicaid enrollment has the potential for negative health impacts, in particular among low-income women with a diagnosis of breast cancer, according to a new study.

In light of bills in both the US House and Senate designed to phase out extra money the federal government has provided to states as an incentive to expand eligibility for Medicaid, a new study shows “Medicaid rollbacks may contribute to widening disparities in health outcomes between low-income women and their wealthier counterparts,” said co-author Lindsay Sabik, PhD, of the University of Pittsburgh.

The Affordable Care Act expanded eligibility for Medicaid, although the Supreme Court later made this expansion voluntary. The proposed American Health Care Act seeks to limit Medicaid enrollment substantially and would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.

Sabik and Wafa Tarazi, PhD, of Virginia Commonwealth University led a team of researchers that examined the health implications of policies that contract Medicaid benefits.

They analyzed Cancer Registry data from 2002 to 2008 in Tennessee and compared women diagnosed with breast cancer who lived in low-income zip codes with a similar group of women who lived in high-income zip codes, before and after Tennessee’s restrictions on Medicaid enrollment in 2005.

The researchers published their results online today in Cancer.

Those women who were diagnosed with breast cancer were more likely to be diagnosed with late-stage disease after a substantial rollback of Medicaid coverage for adults. Women in low-income areas saw the greatest shift to late-stage diagnosis compared to those in higher-income areas.

Overall, non-elderly women in Tennessee were diagnosed at later stages and experienced more delays in treatment in the period after restrictions. There was also a 3.3–percentage point increase in late-stage diagnosis, a 1.9–percentage point decrease in having a delay of more than 60 days in surgery, and a 1.4–percentage point decrease in having a delay of more than 90 days in treatment for women living in low-income zip codes compared with women residing in high-income zip codes.

Sabik noted that late-stage cancer is more costly to treat than early-stage cancer and is associated with a greater risk of death.

“We show that when a large population in a state loses Medicaid coverage, low-income women are more likely to be diagnosed with breast cancer at later stages, suggesting that they did not receive screening or other primary care that may have facilitated earlier diagnosis,” said Tarazi. “Our findings are important for policymakers who are considering changes to the Medicaid program.”

In an accompanying editorial, Sujha Subramanian, PhD, of RTI International in Waltham, Massachusetts, and Nancy Keating, MD, MPH, of Brigham and Women’s Hospital in Boston, noted that federal and state policymakers will likely continue to consider rollbacks of Medicaid expansions to save money or address fiscal shortfalls. “It is important that these policymakers understand that such short-term policies have longer-term consequences for the health of the low-income population, for whom Medicaid is often the only health insurance coverage option,” they wrote.