Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.

Abstract

LBA1 Background: Racial disparities in cancer outcomes remain a societal challenge. The ACA sought to improve equity in healthcare access and outcomes by permitting states to expand Medicaid and providing subsidies for purchase of private insurance. We assessed the impact of Medicaid expansions on racial disparities in time to treatment among patients (pts) with advanced cancer. Methods: We selected pts ages 18-64 years with advanced or metastatic cancer (NSCLC, breast, urothelial, gastric, colorectal, renal cell, prostate, and melanoma), diagnosed between Jan 1, 2011 and Dec 31, 2018, from the nationwide Flatiron Health electronic health record-derived database. We assigned expansion status based on whether the pts’ state of residence had expanded Medicaid as of the diagnosis date. We estimated Medicaid expansion-related changes in the rate of “timely treatment,” an outcome defined as first-line treatment start within 30 days of advanced or metastatic diagnosis. Regression model covariates included race (White, African American, Asian, and Other race), age, sex, practice type, cancer type, stage, and unemployment rate, using time and state fixed-effects. Regression results present predictive margins. Results: The study included 34,067 pts (median age 57 years; 12% African American). Racial disparities were observed pre-expansion: African American pts were 4.9 percentage points (%pt) less likely to receive timely treatment (Table). Regardless of race, Medicaid expansion trended toward an increase in timely treatment overall (p = 0.05). Expansion was associated with a differential benefit for African American vs white pts (6.9 %pt and 1.8 %pt). Prior racial disparities were no longer observed after Medicaid expansion. Conclusions: Implementation of Medicaid expansions as part of the ACA differentially improved African American cancer pts’ receipt of timely treatment, reducing racial disparities in access to care.[Table: see text]

Geographic and demographic features of neuroendocrine tumors in the United States of America: A population‐based study

“…18 In the field of NETs, black patients with pancreatic NETs had worse survival because of a more advanced stage at presentation and relatively limited access to surgery. 5,20,21 With the recent Affordable Care Act Medicaid expansion program, Adamson et al 22 with cancer receiving timely treatment. 5,20,21 With the recent Affordable Care Act Medicaid expansion program, Adamson et al 22 with cancer receiving timely treatment.…”

“…19 However, recent evidence indicates that the racial disparities are going down, and the differences in economic status, insurance coverage, and ease of health care access are becoming more prominent drivers in determining the outcomes of patients with cancer. 5,20,21 With the recent Affordable Care Act Medicaid expansion program, Adamson et al 22 reported improvements in African American patients with cancer receiving timely treatment. Before the Affordable Care Act Medicaid expansion, it was reported that African American patients were 4.9% less likely to receive timely treatment than white patients, whereas after the expansion, the adjusted disparity decreased to 0.2%.…”

The State of Cancer Care in America: Impact of State Policy on Access to High-Quality Cancer Care

“…States that have expanded coverage show improved access to timely care, particularly for racial minorities, whereas those that have not are exhibiting higher uninsured rates. 19 In Texas, a state that has not approved expansion, 4.8 million residents aged ,65 years lack health insurance. 17, 20 Although Medicaid expansion has increased rates of coverage in some states, detractors highlight the unsustainability of the program and its inability to address increasing healthcare costs.…”

“…Step therapy (ST) is a utilization management tool requiring the use of a preferred treatment by the insurance provider before a prescribed therapy is covered. 19 Introduced in an effort to reduce overuse of expensive tests and treatments, ST has been criticized by oncology stakeholders for not containing quality-protecting guardrails or procedures that are critical to severe diseases such as cancer. Providers and patient advocates fault the tool for harming patient outcomes due to clinically inadequate treatment, slow approval times, and excessive administrative burden.…”

Update Mammakarzinom 2019 Teil 5 – diagnostische und therapeutische Herausforderungen neuer personalisierter Therapien bei Patientinnen mit fortgeschrittenem Mammakarzinom

“…Die USAder "Affordable Care Act" Auch in anderen Ländern wie den USA werden solche Zusammenhänge diskutiert und erforscht. Der "Affordable Care Act" in den USA, initiiert durch Barack Obama, hatte das Ziel, mehr Menschen Zugang zu angemessener medizinischer Versorgung zu ermöglichen und dabei gleichzeitig Rassenunterschiede zu beheben [47]. Die Kostenübernahme durch Medicaid sollte zeitnah in den einzelnen Staaten angepasst werden, was aber nicht alle Bundesstaaten in den USA tatsächlich umsetzten.…”