Study: Medicaid expansion has improved early cancer detection for low-income Americans

CLEVELAND — Today, low-income Americans have a much better chance of detecting cancer early on than in the past. Why? According to a new study, the answer to that question is the recent expansion of Medicaid coverage.

In 2010, the Affordable Care Act was introduced, expanding Medicaid coverage for U.S. adults with incomes up to 138% of the federal poverty level. By 2014, most of the ACA’s major provisions had been adopted by many U.S. states. These developments allowed unprecedented Medicaid enrollment, with most new enrollees having never possessed health insurance before.

The study’s authors theorize that all of that additional medical coverage among lower-income Americans must have led to improved health outcomes. More specifically, they hypothesize that many more Americans had been screened for cancer more regularly over the past few years.

Cancer diagnoses before, after Medicaid expansion

In an effort to ascertain if Medicaid expansion has indeed led to faster cancer detection, researchers analyzed data on 12,760 individuals from Ohio. Each adult was between 30 and 64 years old, had been diagnosed with invasive breast, cervical, colorectal, or lung cancer at some point between 2011 & 2016, and was uninsured/enrolled in Medicaid at the time of their diagnosis. The research team focused on comparing data from before the ACA (2011-2013) with data from afterward (2014-2016), and looked to see if patients were diagnosed with early (non-metastatic) or advanced (metastatic) cancer.

Sure enough, cancer patients who were diagnosed after the adoption of expanded Medicaid had a 15% lower chance of being diagnosed with advanced, late-stage cancer in comparison to patients diagnosed before 2014.

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A separate research project was also conducted focusing on middle to high income cancer patients with private insurance. But there was no observed Medicaid influence on early/late cancer detection rates among this demographic.

‘Closing persistent gap in cancer survival’

“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,” says 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, in a release. “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.”

All in all, the study’s authors believe their findings validate the importance of Medicaid. They believe it provides tangible evidence that Medicaid’s expansion helps Americans gain access to the healthcare they need.

“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,” comments lead study author Johnie Rose, MD, PhD, assistant professor at Case Western Reserve University School of Medicine’s Center for Community Health Integration.

The study is published in CANCER.

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