New research found that the likelihood of being diagnosed with advanced cancer decreased among individuals with low income after expansion of Medicaid coverage. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society (ACS).
The Affordable Care Act expanded Medicaid coverage for most adults in the United States 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 may lead to more consistent care, including a greater likelihood that people will be routinely screened for cancer. To examine whether Medicaid expansion has led to earlier cancer detection, Uriel Kim, PhD, 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 individuals in Ohio aged 30 to 64 years who were diagnosed with invasive breast, cervical, colorectal, or lung cancer in 2011 to 2016 and were uninsured or had Medicaid insurance at the time of diagnosis. The investigators compared data before Medicaid expansion (2011 to 2013) and after Medicaid expansion (2014 to 2016), noting whether patients were diagnosed with early (non-metastatic) or advanced (metastatic) cancer.
The team found that individuals with low income diagnosed after Medicaid expansion had 15 percent 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 nonsignificant pre/post-expansion changes in the odds of being diagnosed with metastatic cancer.
"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 Kim. "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's senior author, Johnie Rose, MD, PhD, assistant professor at Case Western Reserve University School of Medicine's Center for Community Health Integration, added that the study highlights the important role that Medicaid expansion has played in increasing access to preventive services, which impact health beyond cancer. "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," he said.
An accompanying editorial notes that the findings are consistent with those from other studies that have examined the impact of Medicaid expansion on cancer outcomes. "The totality of these findings suggests that health coverage through Medicaid is an important predictor of cancer burden, and--critically--of early cancer identification," the authors wrote.