A study published in JAMA Oncology found that the number of uninsured patients with cancer decreased in almost all states following the passing of the Affordable Care Act (ACA), and states that moved to expand Medicaid coverage saw even greater numbers of covered patients.
Researchers conducted a difference-in-differences analysis to determine the percentage of uninsured patients and early-stage cancer diagnoses before (January 1, 2010, to December 31, 2013) and after (January 1, 2014, to December 31, 2014) the ACA and Medicaid expansion.
Population-based study of over 2.5 million nonelderly pts w/#cancer diagnosed 2010-2014 in 40 states reveals broad drop in rate of uninsured pts under Affordable Care Act (ACA), w/most marked drop in states w/Medicaid expansion. https://t.co/tSmB0JWNla pic.twitter.com/ftmmbjO4pQ
— JAMA Oncology (@JAMAOnc) December 16, 2018
Researchers assessed patients 18 to 64 years from the population-based cancer registries of 40 states. The study included 2,471,154 patients (mean age = 52.7 years; range = 18-64 years); half (51.4%) were female and most (70.9%) were non-Hispanic white. The cohort included 1,234,156 patients from states that expanded Medicaid coverage and 1,236,998 patients from states that did not.
In 2014, the percentage of uninsured patients decreased in almost all states; however, decreases were greater in states that expanded Medicaid coverage and were greatest in expansion states with the high baseline uninsured rates.
In Kentucky (expansion state), the percentage of uninsured patients decreased from 8.3% before implementation of the ACA to 2.1% after (−6.2 difference). Comparatively, in Tennessee (non-expansion state), the percentage of uninsured patients decreased from 9.1% before the ACA to 7.5% after (−1.5 difference).
— Anirban Maitra (@Aiims1742) December 15, 2018
In states that expanded coverage, the decreases in the percentage of uninsured patients were higher among minorities and patients in high-poverty or rural areas. Sociodemographic disparities in the percentage of uninsured patients remained high in non-expansion states.
Among states that expanded Medicaid coverage, the stage at cancer diagnosis was slightly earlier compared with non-expansion states.
“Future studies should monitor changes in cancer presentation, treatment, and outcomes after implementation of the ACA,” the researchers concluded.
Source: JAMA Oncology