Medicaid expansion linked to survival gain, reduced disparities among patients with cancer
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The expansion of Medicaid under the Affordable Care Act correlated with an increase in 2-year OS rates among patients newly diagnosed with cancer, according to study results published in JNCI: Journal of the National Cancer Institute.
Improvements in survival for cancer types with a poor prognosis fueled the increase, which appeared greater among Black individuals and residents of rural areas, researchers wrote.
“The narrowing disparities in cancer survival by race and rurality in Medicaid expansion states compared with cancer survival in nonexpansion states are consistent with our hypothesis and our prior research,” Xuesong Han, PhD, scientific director of health services research at American Cancer Society, told Healio. “These findings stand out, because we expect to see widening geographic disparities in cancer survival in the future between people living in expansion states and people living in nonexpansion states.”
Background, methodology
States received incentives as part of the ACA to expand Medicaid to all adults whose incomes are below 138% of the federal poverty level. A dozen states had yet to adopt Medicaid expansion as of April.
“We have observed clear associations of Medicaid expansion with reduced uninsured rate, increases in cancer screening, shifts to early-stage cancers at diagnosis, and declines in problems affording health care among cancer survivors,” Han said. “Whether these gains translate to improved cancer survival is a question that we have been waiting to examine when the data become available. This study took advantage of a recently released population-based cancer registry data set from 42 states to answer the question.”
Using the data set, researchers conducted a difference-in-differences (DD) analysis of 2-year OS among 2,555,302 patients aged 18 to 62 years diagnosed with cancer before (2010-2012) and after (2014-2016) ACA Medicaid expansion and followed through Sept. 30, 2013, and Dec. 31, 2017. Researchers stratified patients by sex, race and ethnicity, census tract-level poverty, and rurality.
Results
Results showed an increase in 2-year OS rates from before to after ACA implementation in both Medicaid expansion states (80.58% to 82.23%) and nonexpansion states (78.71% to 80.04%). This resulted in a net percentage-point increase of 0.44 (95% CI, 0.24-0.64) in expansion states after adjustment for sociodemographic factors.
Researchers observed the largest net percentage-point increases for lung cancer (DD = 1.29; 95% CI, 0.5-2.08), pancreatic cancer (DD = 1.8; 95% CI, 0.4-3.21) and liver cancer (DD = 2.57; 95% CI, 1-4.15).
“They are cancers with poor prognoses for which timely treatment is a strong determinant of short-term survival,” Han told Healio. “The finding suggests improved access to timely and effective cancer treatments in Medicaid expansion states.”
Han and colleagues also reported net increases for colorectal cancer (DD = 0.9 percentage points, 95% CI; 0.19-1.6) and non-Hodgkin lymphoma (DD = 1.07 percentage points; 95% CI, 0.14-1.99).
The greatest improvement in 2-year OS occurred among Black patients (DD = 0.72 percentage points; 95% CI, 0.12-1.31) and those who lived in rural areas (DD = 1.48 percentage points; 95% CI, 0.26-3.23).
Implications
Han said the findings highlight the importance of expanding Medicaid eligibility in all states.
“Medicaid expansion can provide patients with access to timely and affordable care, thus improving cancer outcomes and reducing health disparities,” she told Healio.
Future studies should investigate changes in longer-term health outcomes after ACA implementation, the researchers wrote.
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