Did Pre-Affordable Care Act Medicaid Expansion Increase Access to Surgical Cancer Care?

Abstract

BACKGROUND Although the Affordable Care Act (ACA) expanded Medicaid access, it is unknown whether this has led to greater access to complex surgical care. Evidence on the effect of Medicaid expansion on access to surgical cancer care, a proxy for complex care, is sparse. Using New York’s 2001 statewide Medicaid expansion as a natural experiment, we investigated how expansion affected use of surgical cancer care among beneficiaries overall and among racial minorities. STUDY DESIGN From the New York State Inpatient Database (1997 to 2006), we identified 67,685 nonelderly adults (18 to 64 years of age) who underwent cancer surgery. Estimated effects of 2001 Medicaid expansion on access were measured on payer mix, overall use of surgical cancer care, and percent use by racial/ethnic minorities. Measures were calculated quarterly, adjusted for covariates when appropriate, and then analyzed using interrupted time series. RESULTS The proportion of cancer operations paid by Medicaid increased from 8.9% to 15.1% in the 5 years after the expansion. The percentage of uninsured patients dropped by 21.3% immediately after the expansion (p = 0.01). Although the expansion was associated with a 24-case/year increase in the net Medicaid case volume (p < 0.0001), the overall all-payer net case volume remained unchanged. In addition, the adjusted percentage of ethnic minorities among Medicaid recipients of cancer surgery was unaffected by the expansion. CONCLUSIONS Pre-ACA Medicaid expansion did not increase the overall use or change the racial composition of beneficiaries of surgical cancer care. However, it successfully shifted the financial burden away from patient/hospital to Medicaid. These results might suggest similar effects in the post-ACA Medicaid expansion.

Impact of the Affordable Care Act (ACA) Medicaid Expansion on Cancer Admissions and Surgeries

“…Additionally, the percentage of uninsured patients dropped by 21.3% immediately after the expansion ( P <.01). 13 Furthermore, Loehrer et al evaluated Massachusetts 2006 insurance expansion and found that patients with government-subsidized or self-pay had a 44% increased rate of resection (IRR 1.44; 95% CI, 1.23–1.68, P <.001), a 6.21 percentage point decreased probability of emergent admission (95% CI, 211.88–20.54, P .032), and an 8.13 percentage point increased probability of an elective admission (95% CI, 1.34–14.91, P =.019) compared with the control states. 7 Similarly, we found that Medicaid expansion increased surgical access to cancer patients for surgeries such as lung (IRR 1.30; P <.01), breast (IRR 1.25; P <.02), and colorectal resection (IRR 1.25; P <.001).…”

Impact of Insurance and Practice Type on Access to Orthopaedic Sports Medicine

“…34 In addition, they found that the Medicaid expansion versus nonexpanded states did not have any significant difference in access to care. 34 Multiple other studies 2,21,26 have looked at access to care for orthopaedics among other subspecialties. A previous study 35 showed that Medicaid patients with operative ankle fractures had similar difficulty scheduling an appointment.…”

“…Multiple other studies 2 , 21 , 26 have looked at access to care for orthopaedics among other subspecialties. A previous study 35 showed that Medicaid patients with operative ankle fractures had similar difficulty scheduling an appointment.…”

Identifying factors influencing delays in breast cancer treatment in Kentucky following the 2014 Medicaid expansion

“…This is in contrast to the effect of the 2005 Medicaid disenrollment in Tennessee, which resulted in the later stage of disease at diagnosis of breast cancer and decreased delays to treatment 12 . As studies continue to evaluate the complex interactions between healthcare reform and cancer care, 13 we have attempted to understand other factors related to treatment delays.…”