NY State Medicaid expansion widened racial gap in access to high-quality cancer surgery

October 5, 2017

The 2001 New York State Medicaid expansion—what is considered a precursor to the Affordable Care (ACA)—widened the racial disparity gap when it came to access to high-quality hospitals for cancer surgery, according to a new study from Georgetown University.

The finding surprised the researchers who expected to see a shrinking racial gap, but instead found the proportion of minority Medicaid treated at hospitals that provide high-quality cancer surgery fell significantly compared to their white counterparts.

The New York State Medicaid expansion was the largest in U.S. history before passage of the ACA, which has increased Medicaid enrollment in 32 states as well as the District of Columbia.

The Journal of the American College of Surgeons (JACS) study included 67,685 patients, of which 15 percent were Medicaid beneficiaries or uninsured. Only 12 percent of the Medicaid beneficiaries were African-American and 67 percent were non-Hispanic white.

The researchers conclude that over a 21-month period following the state's Medicaid expansion, racial disparity increased by 18 percentage points in hospitals with the highest volume of cancer surgeries performed—an indicator of quality of surgical cancer care. Racial disparity in access to low-mortality hospitals—another quality measure—showed a similar pattern, increasing by 10 percentage points.

These disparities did not occur because of Medicaid insurance status. Researchers found access to Medicaid patients had increased at these hospitals. The researchers say the reason appears to be because, relative to the expansion, more white Medicaid patients and fewer African-American patients, received cancer surgery at high volume hospitals.

"Low-income non-Hispanic white patients may have been better able to obtain, or take advantage of the benefits of Medicaid for complex surgery," says the study's senior investigator, Waddah B. Al-Refaie, MD, FACS, Georgetown Lombardi Comprehensive Cancer Center Surgeon-In-Chief, and chief of surgical oncology at MedStar Georgetown University Hospital.

"We were very surprised by these unexpected findings," he says.

Al-Refaie adds that this disparity phenomenon may be playing out via the ACA's Medicaid expansion, but this potential issue has not yet been studied.

Al-Refaie says the study focused on measuring and quantifying this issue. As such, reasons behind these widened disparities are still needed. Al-Refaie speculates these aggravated trends could be due to multiple factors including factors (regionalization of specialty care that crowds out some African-American Medicaid patients), physician factors (referral patterns) or patient factors (desire to be treated at more local hospitals rather than regional centers).

This study follows Al-Refaie's finding in January 2017 that New York's Medicaid expansion improved access to for the previously uninsured, but did not preferentially benefit ethnic and racial minorities who are typically the most vulnerable of America's poorest populations. That study was also published in JACS.

"Compelling findings such as these reveal health inequities and drive us to advocate for equitable health policies," says the study's first author, David Xiao, a health justice scholar at Georgetown's School of Medicine.

Explore further: Large pre-ACA Medicaid expansion did not level health disparities in cancer surgery

Related Stories

Large pre-ACA Medicaid expansion did not level health disparities in cancer surgery

January 24, 2017
An analysis of the New York State's Medicaid expansion, which predated the 2010 Affordable Care Act, finds substantial decrease in uninsured rate but little change in racial disparities when it comes to access to cancer surgery ...

Affordable Care Act expands health coverage to more patients, although differences remain

September 12, 2017
Expansion of Medicaid coverage under the Affordable Care Act has contributed to sizeable decreases in medical visits in which people were uninsured. This is true across all racial and ethnic groups, although disparities remain.

ACA Medicaid expansion cut disparities in cancer care for minorities, poor

September 26, 2017
States that fully expanded their Medicaid programs under the Affordable Care Act cut their rates of uninsured cancer patients by more than half between 2011 and 2014. Black patients and those living in the highest poverty ...

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 ...

Medicaid expansion associated with increased Medicaid revenue, decreased uncompensated care costs

October 11, 2016
In a study appearing in the October 11 issue of JAMA, Fredric Blavin, Ph.D., of The Urban Institute, Washington, D.C., estimated the association between Medicaid expansion in 2014 and hospital finances by assessing differences ...

Michigan heart surgery outcomes improved after Medicaid expansion, study finds

June 7, 2017
Expanding Medicaid coverage is associated with better outcomes for heart surgery patients, according to a study led by University of Virginia School of Medicine researchers.

Recommended for you

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

Defining optimal opioid pain medication prescription length following surgery

September 27, 2017
A new study led by researchers at the Center for Surgery and Public Health at Brigham and Women's Hospital analyzed opioid prescription data from the Department of Defense Military Health System Data Repository, identifying ...

Is older blood OK to use in a transfusion?

September 27, 2017
(HealthDay)—Using older red blood cells to give transfusions to critically ill patients doesn't appear to affect their risk of dying, Australian researchers report.

0 comments

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.