Medicaid expansion linked to lower uninsured rates

September 8, 2017

New research led by American Cancer Society researchers finds that after full implementation of the Affordable Care Act (ACA), the percent of uninsured decreased substantially in Medicaid expansion states among the most vulnerable patients: low-income nonelderly adults with newly diagnosed cancer. Meanwhile the number of uninsured remained persistently high in nonexpansion states.

The study, appearing in the Journal of Clinical Oncology, also reports a small but statistically significant shift toward earlier diagnosis (stage 1 disease) for some common cancers in patients residing in expansion . The authors say the findings could inform ongoing and reinforces the continued need for additional expansion of access to care, especially for low-income populations.

The Affordable Care Act (ACA) permitted states to expand Medicaid coverage to a broad group of low-income people. As of Jan. 1, 2014, 24 states and the District of Columbia had opted to expand the coverage. While Medicaid expansion has been associated with declines in the percent of uninsured and with improved access to care in the general population, little is known about how it affected insurance coverage and stage at diagnosis among patients with newly diagnosed cancer.

To explore the issue further, investigators led by Ahmedin Jemal DVM Ph.D. looked at coverage changes using data among more than 1.7 million patients ages 18 to 64 diagnosed with a first primary cancer between 2011 and 2014 in the National Cancer Database (NCDB), a hospital-based cancer registry jointly sponsored by the American College of Surgeons and the American Cancer Society that captures approximately 70 percent of all cancer cases in the United States.

They found between the pre-ACA and post-ACA periods, the percent of uninsured decreased from 9.6 percent to 3.6 percent in low-income patients who resided in Medicaid expansion states, whereas it decreased from 14.7 percent to 13.3 percent in those low-income patients residing in nonexpansion states. The authors note that the difference in percent uninsured between low- and high-income groups narrowed substantially in Medicaid expansion states, whereas it remained persistently high in nonexpansion states.

The authors also found a significant, albeit small, shift toward diagnosis of stage I disease for colorectal, lung, female breast, and pancreatic cancers and melanoma in patients who resided in Medicaid expansion states. A similar trend was seen for female breast and lung cancers in nonexpansion states. The authors say the changes are not an extension of past trends, and that their study appears to be the first to document changes in insurance and stage among patients with newly diagnosed cancer after the ACA.

"Coverage status at the time of diagnosis is an important determinant of the initial trajectory of care," write the authors. "The small shift toward early-stage diagnosis for select common cancers, particularly in Medicaid expansion states, adds to the existing evidence on the positive effects of the Affordable Care Act on improving access to and quality of care in low-income population."

"Cancer diagnosed at early stage of the disease are more likely to be treated successfully and have a better chance of cure," said Dr. Jemal. "As such, these findings reinforce the need for the of Medicaid or the formation of a comparable program to ensure access to care for all low-income people regardless of their residence."

Explore further: Insurance expansion under the ACA provides patients with greater hospital choice

More information: Ahmedin Jemal et al, Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients With Cancer After the Affordable Care Act, Journal of Clinical Oncology (2017). DOI: 10.1200/JCO.2017.73.7817

Related Stories

Insurance expansion under the ACA provides patients with greater hospital choice

December 19, 2016
During the first year of Medicaid expansion under the Affordable Care Act (ACA), researchers have seen a meaningful shift in the location and type of emergency department services used by patients. These changes suggest that ...

Medicaid expansion states saw ER visits go up, uninsured ER visits go down

June 19, 2017
States that expanded Medicaid coverage under the Affordable Care Act (the ACA) saw 2.5 emergency department visits more per 1,000 people after 2014, while the share of emergency department visits by the uninsured decreased ...

Medicaid restrictions linked to increased late-stage breast cancer diagnoses

June 26, 2017
Women in Tennessee who were diagnosed with breast cancer were more likely to be diagnosed with late stage disease after a substantial rollback of Medicaid coverage for adults in the state, according to a new analysis. When ...

Medicaid expansion may help prevent kidney failure, improve access to kidney-related care

March 20, 2014
States with broader Medicaid coverage have lower incidences of kidney failure and smaller insurance-related gaps in access to kidney disease care. Those are the findings of a study appearing in an upcoming issue of the Journal ...

Medicaid expansion boosts access, reduces cost for poor

March 9, 2017
States that participated in Medicaid expansion under the Affordable Care Act saw increased insurance rates and access to care, less worry about paying medical bills, but also longer wait times among low-income residents, ...

Medicaid expansion improves breast cancer screening for low-income women

November 30, 2015
Low-income women in Medicaid expansion states in the U.S. are more likely to have a breast screening performed than those in non-expansion states, according to a study presented today at the annual meeting of the Radiological ...

Recommended for you

Study finds being in a good mood for your flu jab boosts its effectiveness

September 25, 2017
New research by a team of health experts at the University of Nottingham has found evidence that being in a positive mood on the day of your flu jab can increase its protective effect.

New tool demonstrates high cost of lack of sleep in the workplace

September 25, 2017
Sleep disorders and sleep deficiency are hidden costs that affect employers across America. Seventy percent of Americans admit that they routinely get insufficient sleep, and 30 percent of U.S. workers and 44 percent of night ...

Maternal diet could affect kids' brain reward circuitry

September 25, 2017
Researchers in France found that rats who ate a junk food diet during pregnancy had heavier pups that strongly preferred the taste of fat straight after weaning. While a balanced diet in childhood seemed to reduce the pups' ...

Breathing dirty air may harm kidneys, study finds

September 21, 2017
Outdoor air pollution has long been linked to major health conditions such as heart disease, stroke, cancer, asthma and chronic obstructive pulmonary disease. A new study now adds kidney disease to the list, according to ...

Excess dietary manganese promotes staph heart infection

September 21, 2017
Too much dietary manganese—an essential trace mineral found in leafy green vegetables, fruits and nuts—promotes infection of the heart by the bacterium Staphylococcus aureus ("staph").

Being active saves lives whether a gym workout, walking to work or washing the floor

September 21, 2017
Physical activity of any kind can prevent heart disease and death, says a large international study involving more than 130,000 people from 17 countries published this week in The Lancet.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.