Medicaid Expansion Has Led to Earlier Cancer Detection Among Americans With Low Income

Following the expansion of Medicaid coverage under the Affordable Care Act, individuals with low income are less likely to be diagnosed with advanced cancer, according to a study published in CANCER.

The passage of the Affordable Care Act expanded Medicaid coverage for most American adults with incomes up to 138% of the federal poverty level. In 2014, many states opted into this expansion and increased coverage in their state, which led to growth in Medicaid enrollment of individuals, many of whom were previously uninsured.

Those individuals now covered by Medicaid will most likely receive more consistent care and regular cancer screenings, allowing for earlier detection of cancer if present, the researchers explained in the study.

In order to investigate this potential for earlier cancer detection, the research team analyzed data from 12,760 individuals in Ohio aged 30 to 64 years who were diagnosed with invasive breast, cervical, colorectal, or lung cancers between 2011 and 2016 and who were uninsured or had Medicaid insurance at the time of diagnosis.

The researchers then compared the data sets from the period before Medicaid expansion (2011 to 2013) and after Medicaid expansion (2014 to 2016), while making note of whether patients were diagnosed with early (non-metastatic) or advanced (metastatic) cancer.

The results demonstrated that individuals with low income who were diagnosed after Medicaid expansion had a 15% decreased likelihood of having metastatic cancer compared with those diagnosed before expansion.

Additionally, as a control, the researchers had developed a separate analysis of data from individuals with private insurance from high-income communities. They found no significant changes regarding the likelihood of being diagnosed with metastatic cancer for these individuals before or after the expansion.

"Cancer stage is the strongest predictor of survival for patients. Long-standing disparities in mortality from screening-amenable cancers between high-income and low-income adults have been driven in large part by differences in metastatic cancer rates," said study co-author Uriel Kim, PhD, a medical student and researcher at Case Western Reserve University School of Medicine's Center, in a press release. "Medicaid expansion under the Affordable Care Act was associated with a significant reduction in the likelihood of being diagnosed with deadly metastatic cancer among Americans with low income. These improvements represent substantial progress in closing a persistent gap in cancer survival between Americans with high and low income."

The study also highlights the ways that Medicaid expansion has increased access to preventive services more generally beyond cancer, explained the study's senior author, Johnie Rose, MD, PhD, assistant professor at Case Western Reserve University School of Medicine's Center for Community Health Integration, in the press release.

"This fact is particularly relevant in the era of the COVID-19 pandemic as tens of millions of people have lost their jobs, and record numbers are expected to rely on safety net programs like Medicaid," Rose said.

The authors also noted that their findings were consistent with the findings of other studies that have examined Medicaid expansion on cancer outcomes. They explained that the cumulative findings demonstrate how important health coverage through Medicaid is as a predictor of cancer burden and early cancer identification.

REFERENCE

Study indicates that Medicaid expansion has led to earlier cancer detection among individuals with low income. Wiley; July 6, 2020. eurekalert.org/pub_releases/2020-07/w-sit070120.php. Accessed August 19, 2020.