ACA Medicaid Expansion Mitigated Racial Disparity in Timely Cancer Care

Expanded Medicare under the Affordable Care Act (ACA) drastically reduced racial disparities in timely cancer care between African American and white patients to the point of nearly eliminating the difference, according to an abstract presented in a plenary session at the 2019 American Society of Clinical Oncology Annual Meeting.

Previous studies have pointed to racial disparities in cancer outcomes as an ongoing challenge in the United States. The ACA intended to improve equity in health care access and outcomes through Medicaid expansion and providing subsidies for individuals to purchase private insurance if they did not qualify for Medicaid, according to the current study. After the 2014 implementation of the ACA, states were granted Medicaid expansion, which led to large increases in enrollment.

For the phase 3 randomized study, the researchers examined de-identified health records from Flatiron Health’s electronic health record (EHR)-derived database. The analysis included data from 30,386 individuals aged 18 to 64 years who were diagnosed with advanced or metastatic solid tumors from January 2011 through January 2019. Patients were assigned to either expanded or not expanded based on whether the state where they live had adopted and implemented Medicaid expansion at the time of their diagnosis.

To evaluate whether Medicaid expansion was associated with reduced racial differences in treatment, the researchers used time to treat as a primary outcome. Patients were evaluated on whether they received treatment within 30 days of an advanced cancer diagnosis.

According to the study, African Americans were 4.8 percentage points less likely to receive timely treatment compared with white patients prior to Medicaid expansion. Following Medicaid expansion, African American patients experienced a 6.1 percentage point improvement in timely treatment compared with a 2.1 percentage point increase among white patients. The study’s findings showed racial disparities were nearly eliminated under Medicaid expansion, with no statistically significant difference in timely receipt of treatment between African American and white patients observed.

“Many studies have described racial disparities that exist in cancer care, but few have shown what types of interventions improve health equity—we now have evidence that Medicaid expansion can mitigate certain health disparities,” study author Amy J. Davidoff, PhD, MS, senior research scientist in Health Policy and Management at the Yale School of Public Health, and a member of the Yale Cancer Center, New Haven, Connecticut, said in a statement about the findings. “We also know that uncertainty about having health insurance, especially for someone newly diagnosed with cancer, can make a big difference in getting appropriate care in a timely manner.”

The study findings support ACA Medicaid expansion as an equalizer in health care. Moving forward, the researchers are developing models to predict what treatment outcomes would be if there was no Medicaid expansion compared with expansion in all states, according to the study.

References

Racial Disparities in Access to Timely Cancer Treatment Nearly Eliminated in States With Medicaid Expansion [news release]. American Society of Clinical Oncology. https://www.asco.org/about-asco/press-center/news-releases/racial-disparities-access-timely-cancer-treatment-nearly. Accessed June 3, 2019.

Davidoff AJ, Blythe JS, Cohen AB, et al. Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment. J Clin Oncol 37, 2019 (suppl; abstra; LBA1).