The likelihood of being diagnosed with advanced cancer decreased among individuals with low income after expansion of Medicaid coverage, new research has found. The findings were published early online in CANCER, a peer-reviewed journal of the American Cancer Society.
The Affordable Care Act expanded Medicaid coverage for most adults in the U.S. with incomes up to 138% of the federal poverty level, and many states opted to do so starting in 2014. This led to increased enrollment in Medicaid, with most new enrollees reporting that they had previously been uninsured.
Providing insurance coverage to these individuals leads to more consistent care, including a greater likelihood that people will be routinely screened for cancer, the study found.
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WHAT'S THE IMPACT?
To examine whether Medicaid expansion has led to earlier cancer detection, Dr. Uriel Kim, a medical student and researcher at Case Western Reserve University School of Medicine's Center for Community Health Integration in Cleveland, Ohio, and his colleagues at the Case Comprehensive Cancer Center, analyzed information pertaining to 12,760 people in Ohio between the ages of 30 to 64 who were diagnosed with invasive breast, cervical, colorectal, or lung cancer from 2011 to 2016 and were uninsured or had Medicaid insurance at the time of diagnosis.
The investigators compared data before Medicaid expansion (2011-2013) and after Medicaid expansion (2014-2016), noting whether patients were diagnosed with early (non-metastatic) or advanced (metastatic) cancer.
The team found that those with low incomes diagnosed after Medicaid expansion had 15% lower odds of having metastatic cancer compared with those diagnosed before expansion. As a control, a separate analysis that focused on individuals with private insurance from high-income communities found insignificant pre/post-expansion changes in the odds of being diagnosed with metastatic cancer.
The stage at which cancer is discovered is the strongest predictor for survival. Metastatic cancer rates have driven many of the survival disparities between high- and low-income patients, which Medicaid expansion has helped to stem, the authors found.
They added that expansion has played an increasingly important role in preventative services even beyond cancer, which is particularly relevant given the COVID-19 pandemic, and the importance of early detection of the virus to contain its effects and spread.
THE LARGER TREND
In February, President Trump proposed a $4.8 trillion budget that would have slashed billions of dollars from Medicaid, food stamps and other safety net programs in an attempt to shrink the federal deficit.
The budget eliminated the enhanced federal match for Medicaid expansion enrollees, and an additional $150 billion would have been shaved off of Medicaid from the implementation of work requirements, which would likely have resulted in people losing their healthcare coverage.
The Republican argument against Medicaid expansion has been the financial risk and the money eventually having to come from other sources in the state budget, but many have softened their stance.
Just months before the presidential election, and with COVID-19 cases on the rise in many areas of the country, the Trump administration filed a brief asking the Supreme Court to invalidate the Affordable Care Act altogether, which again would result in millions of Americans losing coverage.
In the filing, Solicitor General Noel Francisco said the ACA should not remain in effect because the law's individual coverage mandate and two key provisions are invalidated.