Early Medicaid Expansion and Cancer Mortality

Abstract

Background While Medicaid expansion is associated with decreased uninsured rates and earlier cancer diagnoses, no study has demonstrated an association between Medicaid expansion and cancer mortality. Our primary objective was to quantify the relationship between early Medicaid expansion and changes in cancer mortality rates. Methods We obtained county-level data from the National Center for Health Statistics for adults ages 20–64 who died from cancer from 2007–2009 (pre-expansion) and 2012–2016 (post-expansion). We compared changes in cancer mortality rates in early Medicaid expansion states (CA, CT, DC, MN, NJ, and WA) vs. non-expansion states through a difference-in-differences (DID) analysis using hierarchical Bayesian regression. An exploratory analysis of cancer mortality changes associated with the larger-scale 2014 Medicaid expansions was also performed. Results In adjusted DID analyses, we observed a statistically significant decrease of 3.07 (95% credible interval = 2.19 to 3.95) cancer deaths per 100,000 in early expansion vs. non-expansion states, which translates to an estimated decrease of 5,276 cancer deaths in the early expansion states during the study period. Expansion-associated decreases in cancer mortality were observed for pancreatic cancer. Exploratory analyses of the 2014 Medicaid expansions showed a decrease in pancreatic cancer mortality (-0.18 deaths per 100,000, 95% confidence interval = -0.32 to -0.05) in states that expanded Medicaid by 2014 compared to non-expansion states. Conclusion(s) Early Medicaid expansion was associated with reduced cancer mortality rates, especially for pancreatic cancer, a cancer with short median survival where changes in prognosis would be most visible with limited follow-up.

Association of State Medicaid Expansion Status With Rates of Suicide Among US Adults

“… 16 Similarly, early data have also shown associations between Medicaid expansions under the ACA and decreased mortality overall and from cardiovascular, cancer, and other causes. 17 , 18 , 19 , 20 , 21 , 22 Despite significant findings of the mortality-related benefits of Medicaid expansion, data related to the effect on mental health–related mortality remain limited. A recent study 23 that included 8 Medicaid expansion states compared with 7 nonexpansion states demonstrated a modest trend between expansion and improved suicide mortality (1.2 fewer suicides per 100 000 individuals; 95% CI, −2.5 to 0.1), although those findings were not statistically significant.…”

In pursuit of equity in cancer care: Moving beyond the Affordable Care Act

“…As Snyder and colleagues suggest, these findings lend support for the role Medicaid expansion has in improving cancer diagnosis, care, and outcomes, corroborating prior studies 8, 13, 34 . Work using data from patients who receive treatment at community health centers (CHCs), which provide primary care for people who are underserved regardless of insurance status, 35 lends insight into how decreasing barriers to care for people who lack insurance can improve access to cancer screening.…”

“…8 These early findings are encouraging and may herald improved survival outcomes in more cancer types as additional years of data accrue, as has been demonstrated for some cancer types. 13 However, less is known about the equity-that is, work that promotes fairness in outcomes that takes into consideration disparate degrees of barriers to access and social context, 14,15 in contrast to equality, which provides the same support to all groups-with which these benefits are distributed.…”

“…As Snyder and colleagues suggest, these findings lend support for the role Medicaid expansion has in improving cancer diagnosis, care, and outcomes, corroborating prior studies. 8,13,34 Work using data from patients who receive treatment at community health centers (CHCs), which provide primary care for people who are underserved regardless of insurance status, 35 lends insight into how decreasing barriers to care for people who lack insurance can improve access to cancer screening. One study found that in the CHC setting wherein health insurance is not a barrier to care, rates of colorectal and cervical cancer screening increased after implementation of the ACA; the same study found that in the CHC setting, rates of cervical cancer screening increased the most among Black patients in MES.…”

Expanding Medicaid Improves Outcomes in Gynecologic Malignancies, But is it Enough?

“…9 These findings are consistent with those of other studies which note an association between Medicaid expansion and improvement in mortality among patients with gynecologic malignancies and other cancer types. [10][11][12][13] While Medicaid expansion has been shown to improve multiple clinical outcomes, 8,10-13 conclusions about postoperative mortality are constrained by the limitations of large datasets. Cancer-specific mortality, rather than overall mortality, may shed more light on the causes of mortality, and therefore may provide more leads in mortality prevention.…”