June 25, 2018
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Medicaid expansion improves insurance coverage for cancer survivors

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The Patient Protection and Affordable Care Act Medicaid expansion improved coverage and access for cancer survivors, according to study results published in Cancer.

“Before the ACA, cancer survivors were at risk [for] barriers to insurance coverage, including the inability to access employersponsored coverage due to interruptions in or loss of employment or higher premiums in the individual market due to medical underwriting,” Sayeh S. Nikpay, PhD, MPH, assistant professor in the department of health policy at Vanderbilt University School of Medicine, and colleagues wrote. “Lack of insurance in cancer survivors has been associated with [worse] clinical outcomes, increased financial burdens, and delays or interruptions in care. In addition, financial hardship related to cancer has been associated with increased pain, worse symptoms, poorer quality of life and higher mortality.”

Nikpay and colleagues used data from the Behavioral Risk Factor Surveillance System from 2011 to 2015 to compare changes in coverage and health care access for low-income cancer survivors.

The analysis included 17,381 individuals aged 18 to 64 years who were primarily female, white and unmarried.

Among states that expanded Medicaid, the percentage of cancer survivors who were uninsured decreased from 25.3% to 12% (difference, –13.3 percentage points; 95% CI, –18.3 to –8.4). In nonexpansion states, uninsured rates decreased — but to a lesser degree — compared with expansion states (difference, –4.7 percentage points; 95% –7.6 to –1.8).

The proportion of cancer survivors who could not afford to see a physician due to cost fell by 9.1 percentage points (95% CI, –14 to –4.1) among expansion states. Cancer survivors in nonexpansion states did not see a significant improvement in this area (< 0.1 percentage point; 95% CI, –4.7 to 4.31).

Limitations of this study included no data on type and stage of cancer, type of insurance coverage and time since diagnosis.

“The results of the current analysis demonstrate that Medicaid expansion has played a pivotal role in improving insurance coverage and reducing cost barriers to physician care for cancer survivors,” the researchers wrote. “The continuation of current state policies will lead to continued disparities in access and insurance for cancer survivors residing within nonexpansion states, whereas reductions to the Medicaid program risk losing the ground gained over the past 2 years for lowincome cancer survivors in expansion states. Future work investigating the impact of Medicaid expansion on the health and financial outcomes of cancer survivors should be used to guide the direction of future health care policy.” – by Cassie Homer

Reference:

Nikpay SS, et al. Cancer. 2018;doi:10.1002/cncr.31288.

Disclosures: The authors report no relevant financial disclosures.