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Insurance rates rise for head, neck cancer among Medicaid expansion states
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Medicaid expansion under the Affordable Care Act increased insurance rates among patients with head and neck squamous cell carcinoma, according a prospective, observational study.
Prior to implementation of the ACA, patients with insurance had better survival outcomes than uninsured patients.
“The Patient Protection and Affordable Care Act is a nationwide effort to reduce the number of uninsured individuals in the United States and increase access to health care,” Richard B. Cannon, MD, surgeon at Huntsman Cancer Hospital and assistant professor of otolaryngology/head and neck surgery at The University of Utah, told HemOnc Today. “This legislation is commonly debated and objective data are needed to evaluate its impact. As a head and neck cancer surgeon, I sought to evaluate how the ACA had specifically influenced my patients.”
Cannon and colleagues used data from the SEER database to examine rates of insurance coverage and access to care from 2007 to 2014 among states that expanded Medicaid under the ACA in 2014 and those that elected not to expand.
The analysis included 89,038 patients with newly diagnosed HNSCC (67% men; mean age, 59.6 years).
After implementation of the ACA, researchers observed an increase in the proportion of patients with insurance. The percentage enrolled in Medicaid increased from 14.8% to 16.2% (difference, 1.4%; 95% CI, 1.1-1.7), and the percentage with private insurance increased from 78.7% to 80.7% (difference, 1.8%; 95% CI, 1.2-2.4).
Researchers also observed a 3.2% (95% CI, 2.9-3.5) decrease in the number of uninsured patients after ACA implementation (3% vs. 6.2%).
However, these changes only occurred among states that elected to expand Medicaid in 2014.
“Head and neck cancer is often a severe disease with difficult therapy and significant consequences afterward; in addition, there is a high rate of mortality from this disease,” Cannon said. “A large percentage of patients with head and neck cancer are uninsured or underinsured at the time of diagnosis and we know that this significantly impacts their outcomes. Improved access to health care results in earlier stage cancer identification and more curable disease that is ultimately easier to treat.”
No survival data were available for patients with HNSCC after ACA implementation; however, using data from 2007 to 2013, researchers found significantly higher survival rates among those who were insured. Uninsured patients with HNSCC had 14% lower (95% CI, 12.8-15.2) 5-year OS compared with insured patients (48.5% vs. 62.5%) and 15.6% (95% CI, 14-17.2) lower disease-specific survival (56.6% vs. 72.2%).
“Higher rates of insured patients and better outcomes should definitely influence health care policy decisions,” Cannon said. “It is imperative that we have good data to help drive the discussion over health care. As a doctor and human, I firmly believe that we have an obligation to treat everyone to the best of our ability, but I also understand the rising cost of health care and that we need to make treatment affordable.”
The limitations of the study included its observational and retrospective design, the lack of survival data after ACA implementation, and the unmeasured gap between insurance coverage and treatment adherence and healthy living habits.
“This study is just one data point, and we need several others to continually evaluate the effectiveness of the ACA bill,” Cannon said. “We as a medical community need to define the important outcomes and help to shape and influence the debate on health care, because we are the ones fighting on the frontlines.”
In an accompanying editorial, Ryan J. Li, MD, and John McConnell, PhD, of Oregon Health and Science University, summarized the changes in health care policy with the new presidential administration in 2017 and the hurdles facing clinicians who treat patients with head and neck cancers.
“Taking care of our patients ... means more than just developing new treatments,” they wrote. “It is only by maintaining and expanding the coverage gains made with the ACA that we can expect patients to have access to these treatments. Increasingly, the challenges to improving care are unlikely to be restricted solely to the clinical arena but will be largely influenced by the political headwinds that drive federal and state policies.” – by Cassie Homer
For more information:
Richard B. Cannon, MD, can be reached at Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, 50 N Medical Dr, School of Medicine 3C-120, Salt Lake City, UT 84132; richard.cannon@hsc.utah.edu.
Disclosures: The authors, Li and McConnell report no relevant financial diclosures.
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