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Medicaid expansion improves breast cancer care in Kentucky, research shows

Expanding third-party coverage leads to people doing more things that are intrinsically goods for their health.

Jeff Lagasse, Associate Editor

More evidence is in for the effectiveness of the Affordable Care Act in improving certain types of care, with new data showing that women with breast cancer, ages 20 to 64, in Kentucky, have  better outcomes and lower utilization of invasive operations.

Since passage of the ACA in 2010, 31 states and the District of Columbia have expanded Medicaid coverage, with the federal government picking up the tab for the increased costs. In Kentucky, one of the Medicaid expansion states, a University of Louisville study of breast cancer care has found a connection between Medicaid expansion and improved quality of breast cancer care, including an increase in the diagnosis of an early stage in the disease and greater utilization of breast-conserving surgery, instead of more invasive operations such as mastectomy.

[Also: Physicians build bundled payments system for breast cancer]

However, the authors also reported less robust improvements in efficiency and timing of postsurgical therapy.

One of the main conclusions drawn from the research is that expanding third-party coverage leads to people doing more things that are intrinsically good for their health, improving not only outcomes, but overall healthcare spend.

The publication is timely, as the Centers for Medicare and Medicaid Services has already permitted Kentucky to implement a work requirement for able-bodied individuals to receive Medicaid, and as Virginia, a state that has not yet expanded Medicaid, takes up expansion with a work requirement. The Kentucky waiver is already the subject of a court challenge to roll it back.

The researchers chose breast cancer as a measure of Medicaid expansion's impact because, along with colon cancer, it's common. The data showed that from 2011 to 2013, 635,547 screening mammograms were performed in the state; that number increased to 680,418 from 2014 to 2016. In 2011 alone, 208,600 screening mammograms were performed versus 234,315 in 2016. The number of screening mammograms covered by Medicaid increased from 5.6 percent before expansion to 14.7 percent afterward, and the number of women who had screening mammograms and were uninsured declined almost tenfold, from 0.53 percent before to 0.05 percent after expansion.

Breast cancer incidence and treatment rates didn't vary much from year to year. But the changes in the rates of early-stage versus late-stage disease treated in the pre- and post-Medicaid expansion periods were statistically significant. Early stage (Stage I-II) breast cancers accounted for 64.5 percent of the diagnoses in 2011-2013, as opposed to 66.7 percent in 2014-2016. Late-stage (III-IV) cancers comprised 15 percent versus 12.9 percent in the same time frame.

Rates for breast-conserving surgery increased significantly after Medicaid expansion -- from 44 percent pre-expansion to 48.8 percent -- whereas rates of other resections, including mastectomy, declined, from 50.5 percent to 44.5 percent.

The authors said they would re-examine the data in three more years to compile five years' worth of follow-up data.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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