The Affordable Care Act led to an increase in the number of cancer diagnoses -- particularly those at early stages -- in states where Medicaid was expanded, according to research from Indiana University.
Medicaid expansion, wherein the federal government funds states efforts to insure low-income citizen to 138 percent of the federal poverty level, has been contentious since the Affordable Care Act passed. Former Indiana Governor and current Vice President Mike Pence famously voted against the ACA then took federal money to expand the state's Medicaid.
The debate continues raging on Capitol Hill, with Democrats and those on the left favoring expansion, and the GOP and Trump administration decrying what they see as government overreach. Polls show most Americans favor Medicaid expansion, and in 2016 Maine became he first state in the nation to approve expansion through voter referendum, though the state's Republican governor has so far refused to enact it.
The new research, published in the American Journal of Public Health, suggests that having insurance may increase cancer detection, which can lead to fewer deaths and better outcomes for patients.
"Early detection is a key step to reducing cancer mortality, and our findings suggest that Medicaid expansion under the ACA led to more and earlier cancer detection," said the study's co-author, Aparna Soni, in a statement. Soni is a doctoral candidate in business economics and public policy in the IU Kelley School of Business.
Previous research by Soni and her IU co-author, Kosali Simon, the Class of 1948 Herman B. Wells Endowed Professor in the IU School of Public and Environmental Affairs, found that the ACA increased insurance coverage among people already diagnosed with cancer.
In their study, researchers looked at cancer registry data from 2010 through 2014 to estimate post-ACA changes in county-level cancer diagnosis rates, both overall and by stages, in states that expanded Medicaid in 2014 versus those that did not. Medicaid expansion led to an increase of 15.4 early-stage diagnoses per 100,000 people, or 6.4 percent, from pre-ACA levels.
There was no detectable impact on late-stage diagnoses. The overall cancer diagnosis rate increased by 3.4 percent in Medicaid expansion states, compared with non-expansion states.
Using information about patients' age, tumor location and whether the cancer could be screened for, the researchers found that the increase in early-stage diagnoses was largely seen among those age 35 to 54 and with cancers that are easiest to detect.
"The fact that the increase in early-stage diagnoses was concentrated in cancers amenable to screening is consistent with the increase resulting from the expansion of health insurance and access to care," the researchers wrote in the paper.
The increase in overall diagnoses was largely driven by increases among those age 45 to 54 and among those with prostate cancer.