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Medicaid expansion leads to earlier cancer detection
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States with expanded Medicaid under the Affordable Care Act demonstrated an increase in cancer diagnoses, especially early-stage cancer diagnoses, according to study results.
“Our study found that the ACA Medicaid expansion increased overall cancer diagnosis rates by 4% and early-stage diagnosis rates by 6%,” Aparna Soni, MA, doctoral candidate in business economics and public policy at Indiana University Kelley School of Business, told HemOnc Today. “These findings suggest that expanding public health insurance can be an effective way to increase early cancer detection, which is important for increasing the probability of successful treatment, reducing mortality and controlling costs.”
Although it is known the 2014 Medicaid expansions improved access to care among nonelderly adults, it had not been known how the expansions affected cancer diagnoses.
Soni and colleagues used the SEER database to study first cancer diagnosis rates among adults aged 19 to 64 years in U.S. states that expanded Medicaid in 2014 compared with those that did not. Nine of the 13 states included in SEER expanded Medicaid by 2014.
Among the 611 counties included in the study, overall cancer diagnosis increased 3.4% in the first year from pre-expansion levels, to 13.8 (95% CI, 0.7-26.9) per 100,000 people. Early-stage diagnosis increased by 6.4%, to 15.4 (95% CI, 5.4-25.3) per 100,000 people.
Late-stage diagnosis did not change significantly.
“Clinicians who are practicing in states that experienced large increases in insurance coverage due to the ACA (ie, states that expanded Medicaid) may see an increase in newly insured patients who are now able to access recommended preventive care and cancer screenings,” Soni told HemOnc Today. “They may also see patients coming into the doctor’s office right away if they notice unusual pain or cancer-like symptoms, rather than waiting until it’s too late.”
Researchers found that cancer detection among those aged 35 to 54 years and of cancers amenable to screening largely drove the increase in early-stage diagnoses.
Researchers acknowledged that the main limitation of the study was the availability of only 1 year of post-2014 data from only 13 states.
“As the nation continues to debate health care reform, our findings suggest that reducing Medicaid funding could reduce doctors’ and patients’ ability to detect cancer at earlier stages,” Soni said. “It is also important to remember that not all states have expanded Medicaid. For the 18 states that have not yet adopted the Medicaid expansion, expanding their public health insurance programs may improve cancer detection, which is associated with better patient outcomes, including reduced mortality.” - by Cassie Homer
For more information:
Aparna Soni , MA , can be reached at Indiana University, 1310 E Tenth St., Bloomington, IN 47405; email: apsoni@indiani.edu.
Disclosures: The authors report no relevant financial disclosures.
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Soni A, et al. Am J Public Health. 2017;doi:10.2105/AJPH.2017.304166.
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