Medicaid expansion leads to decline in cancer outcome disparities across low-income areas
Expansion of Medicaid under the Affordable Care Act appeared associated with a reduction in critical cancer outcome disparities among adults residing in low-income communities in Ohio, according to study results published in Cancer.
“Several studies have looked at access and process of care measures in relation to the ACA. We wanted to understand how a key provision of the ACA, Medicaid expansion, might affect a clinical outcome strongly linked to survival,” Uriel Kim, BS, researcher at the Center for Community Health Integration at Case Western Reserve University School of Medicine, told Healio. “It is important to understand the population health implications of Medicaid expansion, because this information may inform future policy decisions and especially because more than a dozen states have not yet expanded their Medicaid programs under ACA.”
Kim and colleagues sought to estimate the effect of Medicaid expansion among 12,760 adults diagnosed with screening-amendable metastatic breast, cervical, colorectal or lung cancer between 2011 and 2016. Study participants resided in low-income communities in Ohio, which was part of the first round of Medicare expansion in 2014, and were underinsured or had Medicaid insurance at the time of diagnosis.
The researchers gathered state registry data associated with block group-level income data. They used a multivariable logistic model to examine the independent association between Medicaid exposure in the period before (2011-2013) and after (2014-2016) expansion and cancer outcomes.
Results showed those diagnosed in the post-expansion years had 15% lower odds of having metastatic disease than those diagnosed in the pre-expansion years (adjusted OR = 0.85; 95% CI, 0.77-0.93).
“The magnitude of the effect was most surprising — a 15% reduction among this vulnerable group is a significant effect in such a short period of time,” Kim said. “This represents a meaningful improvement in a stubborn health disparity — an improvement that will translate to lives saved.”
In a separate analysis that examined adults with private insurance who resided in high-income communities, researchers observed no significant differences in changes in the odds of being diagnosed with metastatic disease between the pre-expansion and post-expansion years (adjusted OR = 1.02; 95% CI, 0.96-1.09).
“Catching these screening-amenable cancers early will save lives. Short of developing new treatments, earlier diagnosis is the shortest route to decreasing cancer mortality quickly,” Kim said. “Although other ACA measures improve screening access, Medicaid expansion targets a particularly vulnerable group that tends to face the worst cancer outcomes. The economic devastation occurring in the wake of COVID-19 will unfortunately provide a natural experiment — we will be able to compare how newly jobless Americans fare in terms of cancer and other health outcomes between states that expanded Medicaid and those that did not. It will be interesting to look at the nonscreening-amenable cancers to understand the extent to which having access to nonemergent care through Medicaid expansion will promote earlier diagnosis.”
Medicaid expansion, which has been implemented by 37 states under the ACA since 2014, increased the percentage of insured Americans and provided more than 12 million low-income adults in the U.S. with health care coverage through Medicaid programs. Given the increased coverage, the expansion of Medicaid serves as an opportunity to better assess and understand the role of insurance coverage in disease-specific outcomes, Hala T. Borno, MD, oncologist in the department of medicine at University of California, San Francisco, and colleagues wrote in an accompanying editorial.
“Kim and colleagues have reported evidence of success in reducing the gap in access through the Medicaid expansion scheme in Ohio,” they wrote. “These findings in Ohio may be due to a combination of limited cost-sharing under the Medicaid plans and the expansion of the program. Nevertheless, expanding health care access is only a first step toward building a robust health care and health insurance system. In addition to health care access for all, it is critical to ensure comprehensive coverage for all.”
- Borno HT, et al. Cancer. 2020;doi:10.1002/cncr.33039.
- Kim U, et al. Cancer. 2020;doi:10.1002/cncr.32895.
For more information:
Uriel Kim, BS, can be reached at Case Western Reserve University School of Medicine, 11000 Cedar Ave., Suite 402, Cleveland, OH 44106; email: firstname.lastname@example.org.