Medicaid expansion in Kentucky improves breast cancer care for women 20 to 64 years old

February 12, 2018, American College of Surgeons

Since passage of the Affordable Care Act in 2010, 32 states and the District of Columbia have expanded Medicaid coverage, with the federal government picking up the tab for the increased costs. In Kentucky, one of the Medicaid expansion states, a University of Louisville study of breast cancer care has found a connection between Medicaid expansion and improved quality of breast cancer care, including an increase in diagnosis of early stage disease and greater utilization of breast-conserving surgery instead of more invasive operations such as mastectomy. However, study authors also reported less robust improvements in efficiency and timing of postsurgical therapy.

"What we learned is that the of some form of third-party coverage for health care leads to people doing more things that are intrinsically good for their health," said senior study author Hiram C. Polk, Jr. MD, FACS, of the division of surgical oncology in the department of surgery named for him at the University of Louisville. The study, first presented at the Southern Surgical Association 129th annual meeting in December 2017, appears as an "article in press" on the website of the Journal of the American College of Surgeons in advance of print publication.

The publication is timely, as the Centers for Medicare and Medicaid Services has already permitted Kentucky to implement a work requirement for able-bodied individuals to receive Medicaid, and as Virginia, a state that has not yet expanded Medicaid, takes up expansion with a work requirement. The Kentucky waiver is already the subject of a court challenge to roll it back.

Dr. Polk explained the rationale for using as a marker of the impact of Medicaid expansion. "Breast cancer and colon cancer are very common cancers," he said. "Our goal was to get an early measure of what really happened with Medicaid expansion." The study evaluated measures related to breast cancer from 2011 to 2016, using 2014, the year Kentucky's Medicaid expansion went into effect, as the cutoff between the pre- and post-Medicaid expansion periods. "We knowingly took on the onus of possibly making too early of an observation on Medicaid expansion, but the degree of change that occurred so promptly in two years surprised me," Dr. Polk said.

The study queried the Kentucky Cancer Registry for all women age 20 to 64 diagnosed with breast cancer between 2011 and 2016. From 2011 to 2013, 635,547 screening mammograms were performed in the state; that number increased to 680,418 from 2014 to 2016. In 2011 alone, 208,600 screening mammograms were performed vs. 234,315 in 2016. The number of screening mammograms covered by Medicaid increased from 5.6 percent before expansion to 14.7 percent after, and the number of women who had screening mammograms and were uninsured declined almost tenfold, from 0.53 percent before to 0.05 percent after expansion.

Dr. Polk, who served one year as Kentucky's public health commissioner under current Kentucky Gov. Matt Bevin, said of the sharp increase in mammography rates in Kentucky, "It bent the curve upward."

Breast incidence and treatment rates did not vary significantly from year to year. However, the changes in the rates of early-stage vs. late-stage disease treated in the pre- and post-Medicaid expansion periods were statistically significant. Early stage (stage I-II) breast cancers accounted for 64.5 percent of the diagnoses in 2011-2013 vs. 66.7 percent in 2014-2016; late-stage (III-IV) cancers comprised 15 percent vs. 12.9 percent in the respective periods (p=0.002).

Rates for -conserving surgery increased significantly after Medicaid expansion—from 44 percent pre-expansion to 48.8 percent (p<0.001)—whereas rates of other resections, including mastectomy, declined—from 50.5 percent to 44.5 percent.

While time from diagnosis to surgical treatment for the disease was shorter before expansion—an average of 28.6 days vs. 36 (p<0.001)—two other key treatment variables were either unchanged or improved after expansion: time from the operation to chemotherapy (47.5 days before expansion and 46.6 days after, p=0.26); and time from the operation to radiation (96.4 days vs. 91.5, p<0.001).

The study noted that the findings mirrored those of other state experiences with either expansion or contraction of Medicaid programs, but Dr. Polk said that a thorough analysis of the Medicaid expansion in Kentucky requires a longer-term study. "This needs to be re-done in three more years so we have five years of follow-up," he explained.

Explore further: Medicaid expansion leads to increase in early-stage cancer diagnoses

More information: Evaluating the Early Impact of Medicaid Expansion on the Quality of Breast Cancer Care in Kentucky. Journal of the American College of Surgeons. Available at: www.journalacs.org/article/S10 … (18)30022-X/fulltext

Related Stories

Medicaid expansion leads to increase in early-stage cancer diagnoses

December 21, 2017
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 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 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 ...

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 cuts out-of-pocket spending

February 2, 2018
(HealthDay)—States that expanded Medicaid cut the probability of non-elderly near-poor adults being uninsured and lowered average out-of-pocket spending, according to a study published online Jan. 24 in Health Affairs.

Medicaid expansion linked with better, more timely surgical care

January 24, 2018
The Affordable Care Act's Medicaid expansion was linked to better access to surgery and higher quality surgical care, according to a new study from Harvard T.H. Chan School of Public Health.

Recommended for you

Clues found to early lung transplant failure

May 21, 2018
Among organ transplant patients, those receiving new lungs face a higher rate of organ failure and death compared with people undergoing heart, kidney and liver transplants. One of the culprits is inflammation that damages ...

In breakthrough, surgeon builds windpipes from arteries

May 20, 2018
Where others failed, sometimes spectacularly, French surgeon Emmanuel Martinod has helped people whose windpipes have been ravaged by cancer and other diseases to live and breathe normally again.

Blood type O patients may have higher risk of death from severe trauma

May 1, 2018
Blood type O is associated with high death rates in severe trauma patients, according to a study published in the open access journal Critical Care that involved 901 Japanese emergency care patients.

Brains, eyes, testes: off-limits for transplants?

April 28, 2018
Since the world's first successful organ transplant in 1954—a kidney—the discipline has advanced to the point where a wounded soldier could have his penis and scrotum replaced in a groundbreaking operation last month.

Emergency treatment by older surgeons linked to slightly lower death rates

April 26, 2018
Patients undergoing emergency surgery who are treated by older surgeons (aged 60 or over) have slightly lower death rates in the first few weeks after their operation than patients treated by younger surgeons (aged less than ...

Bionic suit helps paralyzed patients stand and walk again

April 25, 2018
Patients undergoing physical rehabilitation at Rush for paralyzing injuries are being aided by a robotic suit designed to help raise people to full height and walk.

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.