Medicaid expansion and access to care among cancer survivors: a baseline overview

Abstract

Purpose Medicaid expansion under the Affordable Care Act facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Medicaid expansions may provide increased access to care for cancer survivors, a growing population with chronic conditions. We compare access to healthcare services among cancer survivors living in non-expansion states to those living in expansion states, prior to Medicaid expansion under the Affordable Care Act. Methods We use the 2012 and 2013 Behavioral Risk Factor Surveillance System to estimate multiple logistic regression models to compare inability to see a doctor because of cost, having a personal doctor, and receiving an annual checkup in the past year between cancer survivors who lived in non-expansion states and survivors who lived in expansion states. Results Cancer survivors in non-expansion states had statistically significantly lower odds of having a personal doctor (adjusted odds ratio [AOR] 0.76; 95 % confidence interval [CI] 0.63–0.92; p<0.05) and higher odds of being unable to see a doctor because of cost (AOR 1.14, 95 % CI 0.98–1.31, p<0.10). Statistically significant differences were not found for annual checkups. Conclusions Prior to the passage of the Affordable Care Act, cancer survivors living in expansion states had better access to care than survivors living in non-expansion states. Failure to expand Medicaid could potentially leave many cancer survivors with limited access to routine care. Implications for Cancer Survivors Existing disparities in access to care are likely to widen between cancer survivors in Medicaid non-expansion and expansion states.

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors

“…Low‐income cancer survivors residing in nonexpansion states served as a control group for low‐income cancer survivors residing in expansion states. This quasi‐experimental design has the additional advantage of accounting for preexisting differences in access to care between expansion and nonexpansion states before ACA implementation …”

“…This quasi-experimental design has the additional advantage of accounting for preexisting differences in access to care between expansion and nonexpansion states before ACA implementation. 14…”

“…Those with access to Medicaid gain comprehensive coverage for free and face low out‐of‐pocket medical costs for care. Before the ACA, cancer survivors residing in nonexpansion states were less likely to have a personal physician and were more likely to have cost barriers to seeing a physician compared with those residing in expansion states . Although Medicaid expansion has been associated with improvements in insurance rates, physician access, and medication adherence in a general population, the high cost of cancer therapy as well as the historically lower specialty physician reimbursement levels raised concern as to whether the expansion of Medicaid would translate into improved medical care access and affordability for cancer survivors …”

“…Before the ACA, cancer survivors residing in nonexpansion states were less likely to have a personal physician and were more likely to have cost barriers to seeing a physician compared with those residing in expansion states. 14…”

Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care

“…Consequently, and given the large amount of treatment and follow up care for cancer patients, Medicaid has been linked with lower odds of foregoing care due to costs among cancer survivors. 25 …”