Research Update: Early Evidence on Medicaid Expansion’s Important Role Fighting Cancer

This week, I am reading studies showing new evidence that the Medicaid expansion is contributing to the fight against cancer.

Medical Care’s Changes in Health Insurance Coverage Associated With the Affordable Care Act Among Adults With and Without a Cancer History: Population-based National Estimates

The researchers examined coverage changes for adults with and without a cancer history after the ACA. They used data from the National Health Interview Survey between 2012 and 2015.

What it finds

  • The uninsured rate for cancer survivors decreased from 12.4% to 7.7% after ACA implementation.
  • Among cancer survivors newly eligible for Medicaid, the uninsured rate decreased by more than 70% from 25.8% to 7.4%.

Why it matters

  • There are roughly 528,000 adults with a cancer history who remain uninsured and expanding Medicaid would likely help decrease that number.
  • The authors estimate that 16.2% of uninsured cancer survivors fall in the coverage gap. They likely do not have access to affordable health coverage because they live in states that did not expand Medicaid and they are not eligible for Marketplace subsidies.
  • There are many uninsured adults eligible but unenrolled in Medicaid. The authors estimate that 11.5% of uninsured cancer survivors and 20.9% of uninsured adults without a cancer history are likely eligible for Medicaid.

Journal of Oncology Practice’s Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act

Duke University Medical Center researchers analyzed insurance coverage among patients under age 65 diagnosed with colon, lung, or breast cancer between 2008 and 2014. Insurance rates were examined from 2011-2013 (before the ACA) and for 2014 (after the ACA) in 9 expansion states and 5 non-expansion states.

What it finds

  • There was a significant increase in patients enrolled in Medicaid in expansion states.
  • The uninsured rates for patients in expansion states with a new diagnosis of lung or colon cancer decreased by at least 50%.
  • The uninsured rate for patients in expansion states with a new diagnosis of breast cancer decreased by over 40%.

Why it matters

  • The decline in the rate of uninsured did not decrease for patients living in non-expansion states.
  • Results indicate that the Medicaid expansion provided insurance coverage for patients diagnosed with colon, lung, and breast cancer.

Journal of the American College of Surgeons’ Early Impact of Medicaid Expansion and Quality of Breast Cancer Care in Kentucky

Researchers in Kentucky evaluated the early impact of the Medicaid expansion on coverage for breast cancer patients and quality of care. They analyzed data on women ages 20-64 diagnosed with breast cancer between 2011 and 2016. They compared data from 2011-2013 (pre-expansion) to 2014-2016 (post-expansion)

What it finds

  • The percentage of breast cancer patients who were uninsured in Kentucky decreased from 3.7% to 1.0%.
  • The percentage of breast cancer patients who were covered through Medicaid increased from 10.9% to 15.9%.
  • The annual number of mammograms increased over the time period. There was an increase in the percent of mammograms covered by Medicaid, from 5.6% to 14.7%, and a decrease in the percent of mammograms for the uninsured, from .53% to .05%.

Why it matters

  • The authors find that Medicaid expansion in Kentucky is associated with earlier diagnosis of breast cancer. There are also signs of improved quality of breast cancer care.
  • Breast cancer patients in Kentucky were less likely to be uninsured and more likely to have Medicaid after the Medicaid expansion, which likely led to greater economic security given the high cost of cancer care.  
Karina Wagnerman
Karina Wagnerman is a Senior Health Policy Analyst at the Center for Children and Families