States That Expanded Medicaid Under Obamacare Reduced Cancer Care Disparities | By Benjamin Ryan @Pharmative
The red–blue divide of state legislatures largely decided whether uninsured Americans diagnosed with cancer were able to get health coverage after the 2014 phase of the Affordable Care Act (ACA, or Obamacare) implementation. With Republican-dominated states generally refusing to expand their Medicaid programs under Obamacare, the mostly blue states that proceeded with the expansion saw their uninsured rates among cancer patients cut in half according to a new analysis from Duke University Medical Center.
Meanwhile, cancer patients living in non-expansion states experienced only a small drop in their overall uninsured rate in 2014.
The Medicaid expansion that did occur provided the greatest benefit to uninsured cancer patients who lived in the worst poverty. The health policy shift also reduced racial disparities in access to insurance among the cancer population in expansion states.
Previous research has found that cancer patients without insurance have worse treatment outcomes and are more likely to receive subpar care, including a lack of cancer-targeting surgery and radiation, compared with those who do have insurance.
A major 2012 Supreme Court decision granted states the option of refusing to follow the ACA’s directive to expand their Medicaid programs to all those with incomes below 138 percent of the federal poverty level ($16,643 in 2017 dollars). The states that followed this expansion began doing so in January 2014.
Presenting their findings at the annual meeting of the American Society for Radiation Oncology (ASTRO) in San Diego, researchers at the Duke Cancer Institute studied records from a National Cancer Institute database. They looked at insurance status and disparities in health coverage among cancer patients before the Medicaid expansion—from January 2011 to December 2013—and after, meaning all of 2014.
The investigators ultimately analyzed data about 197,000 people 18- to 64-years-old who had a median age of 55 and received radiation for any type of cancer between 2011 and 2014. At the time of their diagnosis, 73 percent of these individuals lived in states that expanded Medicaid in 2014.
Compared with those who lived in expansion states, the study population living in the non-expansion states was, on average, older, had a higher proportion of African Americans, had higher rates of lack of insurance before the expansion, and had higher rates of poverty.
The rates of lack of insurance among cancer patients dropped in expansion and non-expansion states alike, but to a much greater extent in the states that opted to broaden their Medicaid coverage under the ACA.
In non-expansion states, what bump in insured rates that did occur primarily benefited whites and those living in areas with low levels of poverty. Black residents with cancer in these states, along with individuals living high-poverty areas, essentially saw no change in their insured rates.
Among cancer patients in the expansion states, the uninsured rate dropped by 53 percent after the expansion in 2014, from 4.3 percent to 2.1 percent. The proportion receiving Medicaid rose from 15.2 percent to 18 percent. In the states that did not expand Medicaid, the uninsured rate dropped just 5 percent in 2014, from 8.4 percent to 8 percent, as the proportion receiving insurance from sources other than Medicaid rose from 75.7 percent to 77.1 percent.
The uninsured rate for those people living with cancer in the most severe quartile of poverty dropped 60 percent, from 4.5 percent to 1.8 percent; in non-expansion states, the corresponding rate for this group stayed essentially flat at about 11 percent.
In the expansion states, the respective uninsured rates of black and white people with cancer began at 6 percent and 4.3 percent; in 2014 this gap narrowed as the corresponding rates dropped to 3 percent and 1.9 percent.
“The debate over health care reform is ongoing,” said the study’s lead author Fumiko Chino, MD, a radiation oncologist at Duke. “Our findings indicate that Medicaid expansion was effective at decreasing disparities and improving access to care for cancer patients receiving radiation, but some disparities still exist.”
According to Chino, his team is now investigating whether such rising insurance rolls among individuals with cancer translate to improved survival.
Sources:
Press release: https://www.eurekalert.org/pub_releases/2017-09/dumc-ame092517.php
The press briefing with the video, slides and some photos:
https://www.astro.org/News-Briefing-3.aspx
TAGS: #ACA #AffordableCareAct #ObamaCare #MedicAidExpansion #DukeCancerInstitute #TakeCharge @Pharmative
All of this progress could very severely compromised by the Republican tax bill, which by starving the treasury will likely prompt the GOP to go after entitlements such as Medicaid to fill the void in the U.S. Treasurythat they've created with the bill.
Ben, great informative article. It's important to continue to evaluate and inform others on all the successes of Obamacare, especially at this time. Stay healthy, Dr. J.
The red–blue divide of state legislatures largely decided whether uninsured Americans diagnosed with cancer were able to get health coverage after the 2014 phase of the Affordable Care Act (ACA, or Obamacare) implementation. With Republican-dominated states generally refusing to expand their Medicaid programs under Obamacare, the mostly blue states that proceeded with the expansion saw their uninsured rates among cancer patients cut in half according to a new analysis from Duke University Medical Center.
Meanwhile, cancer patients living in non-expansion states experienced only a small drop in their overall uninsured rate in 2014.
The Medicaid expansion that did occur provided the greatest benefit to uninsured cancer patients who lived in the worst poverty. The health policy shift also reduced racial disparities in access to insurance among the cancer population in expansion states.
Previous research has found that cancer patients without insurance have worse treatment outcomes and are more likely to receive subpar care, including a lack of cancer-targeting surgery and radiation, compared with those who do have insurance.
A major 2012 Supreme Court decision granted states the option of refusing to follow the ACA’s directive to expand their Medicaid programs to all those with incomes below 138 percent of the federal poverty level ($16,643 in 2017 dollars). The states that followed this expansion began doing so in January 2014.
Presenting their findings at the annual meeting of the American Society for Radiation Oncology (ASTRO) in San Diego, researchers at the Duke Cancer Institute studied records from a National Cancer Institute database. They looked at insurance status and disparities in health coverage among cancer patients before the Medicaid expansion—from January 2011 to December 2013—and after, meaning all of 2014.
The investigators ultimately analyzed data about 197,000 people 18- to 64-years-old who had a median age of 55 and received radiation for any type of cancer between 2011 and 2014. At the time of their diagnosis, 73 percent of these individuals lived in states that expanded Medicaid in 2014.
Compared with those who lived in expansion states, the study population living in the non-expansion states was, on average, older, had a higher proportion of African Americans, had higher rates of lack of insurance before the expansion, and had higher rates of poverty.
The rates of lack of insurance among cancer patients dropped in expansion and non-expansion states alike, but to a much greater extent in the states that opted to broaden their Medicaid coverage under the ACA.
In non-expansion states, what bump in insured rates that did occur primarily benefited whites and those living in areas with low levels of poverty. Black residents with cancer in these states, along with individuals living high-poverty areas, essentially saw no change in their insured rates.
Among cancer patients in the expansion states, the uninsured rate dropped by 53 percent after the expansion in 2014, from 4.3 percent to 2.1 percent. The proportion receiving Medicaid rose from 15.2 percent to 18 percent. In the states that did not expand Medicaid, the uninsured rate dropped just 5 percent in 2014, from 8.4 percent to 8 percent, as the proportion receiving insurance from sources other than Medicaid rose from 75.7 percent to 77.1 percent.
The uninsured rate for those people living with cancer in the most severe quartile of poverty dropped 60 percent, from 4.5 percent to 1.8 percent; in non-expansion states, the corresponding rate for this group stayed essentially flat at about 11 percent.
In the expansion states, the respective uninsured rates of black and white people with cancer began at 6 percent and 4.3 percent; in 2014 this gap narrowed as the corresponding rates dropped to 3 percent and 1.9 percent.
“The debate over health care reform is ongoing,” said the study’s lead author Fumiko Chino, MD, a radiation oncologist at Duke. “Our findings indicate that Medicaid expansion was effective at decreasing disparities and improving access to care for cancer patients receiving radiation, but some disparities still exist.”
According to Chino, his team is now investigating whether such rising insurance rolls among individuals with cancer translate to improved survival.
Sources:
Press release: https://www.eurekalert.org/pub_releases/2017-09/dumc-ame092517.php
The press briefing with the video, slides and some photos:
https://www.astro.org/News-Briefing-3.aspx
TAGS: #ACA #AffordableCareAct #ObamaCare #MedicAidExpansion #DukeCancerInstitute #TakeCharge @Pharmative
All of this progress could very severely compromised by the Republican tax bill, which by starving the treasury will likely prompt the GOP to go after entitlements such as Medicaid to fill the void in the U.S. Treasurythat they've created with the bill.
@Ben Ryan So true.
Ben, great informative article. It's important to continue to evaluate and inform others on all the successes of Obamacare, especially at this time. Stay healthy, Dr. J.