Medicaid Coverage Expansion and Implications for Cancer Disparities

Choi, Seul Ki; Adams, Swann Arp; Eberth, Jan M.; Brandt, Heather M.; Friedman, Daniela B.; Tucker-Seeley, Reginald; Yip, Mei Po; Hébert, James R.

doi:10.2105/ajph.2015.302876

Cited by 62 publications

(41 citation statements)

References 18 publications

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“…This is promising news for HC patients of Medicare‐eligible age. However, among uninsured HC patients, the lack of health insurance continued to be a barrier to the receipt of CRC screening . Although the Affordable Care Act has mandated insurance coverage for CRC screening since September 2010 in many types of plans, state‐sponsored low‐ or no‐cost cancer screenings as well as programs that engage gastroenterology practices to provide subsidized or pro bono colonoscopies continue to be important for patients who are not yet eligible for Medicare and require higher cost tests because of the risk status, positive initial stool blood screening, or patient preference .…”

Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

Lin

McKinley

Sripipatana

et al. 2017

Cancer

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The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

Lin

McKinley

Sripipatana

et al. 2017

Cancer

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“…13 CHCs represent the primary care safety net system in the United States, and receive federal funding to serve vulnerable populations (ie, low-income and publicly insured or uninsured patients). 14,15 Nevertheless, the majority of cancer survivorship studies to date have been conducted using cancer registry data, 16,17 survey data, 18 or within academic health centers. 14,15 Nevertheless, the majority of cancer survivorship studies to date have been conducted using cancer registry data, 16,17 survey data, 18 or within academic health centers.…”

Section: Introductionmentioning

confidence: 99%

Identifying and characterizing cancer survivors in the US primary care safety net

Hoopes

Schmidt

Huguet

et al. 2019

Cancer

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BACKGROUND: Primary care providers must understand the use patterns, clinical complexity, and primary care needs of cancer survivors to provide quality health care services. However, to the authors' knowledge, little is known regarding the prevalence and health care needs of this growing population, particularly in safety net settings. METHODS: The authors identified adults with a history of cancer documented in primary care electronic health records within a network of community health centers (CHCs) in 19 states. The authors estimated cancer history prevalence among >1.2 million patients and compared sex-specific site distributions with national estimates. Each survivor was matched to 3 patients without cancer from the same set of clinics. The demographic characteristics, primary care use, and comorbidity burden then were compared between the 2 groups, assessing differences with absolute standardized mean differences (ASMDs). ASMD values >0.1 denote meaningful differences between groups. Generalized estimating equations yielded adjusted odds ratios (aORs) for select indicators. RESULTS: A total of 40,266 cancer survivors were identified (prevalence of 3.0% of adult CHC patients). Compared with matched cancer-free patients, a higher percentage of survivors had ≥6 primary care visits across 3 years (62% vs 48%) and were insured (83% vs 74%) (ASMD, >0.1 for both). Cancer survivors had excess medical complexity, including a higher prevalence of depression, asthma/chronic obstructive pulmonary disease, and liver disease (ASMD, >0.1 for all). Survivors had higher odds of any opioid prescription (aOR, 1.23; 95% CI, 1.19-1.27) and chronic opioid therapy (aOR, 1.27; 95% CI, 1.23-1.32) compared with matched controls (P < .001 for all). CONCLUSIONS: Identifying cancer survivors and understanding their patterns of utilization and physical and mental comorbidities present an opportunity to tailor primary health care services to this population. Cancer 2019;125:3448-3456.

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“…30 While the studies generally suggest that the ACA is likely to lead to improvements in screening and early diagnosis, they also highlight that given variation in Medicaid expansion across states, existing disparities in screening may be expected to widen nationally after ACA implementation. 31,32 Further, given remaining gaps in insurance coverage under the ACA’s provisions, projections of the number of women likely to remain uninsured highlight the potential continued need for support of screening services for uninsured women through the CDC’s Breast and Cervical Cancer Early Detection Program. 33,34 …”

Section: Resultsmentioning

confidence: 99%

The ACA and Cancer Screening and Diagnosis

Sabik¹,

Adunlin²

2017

Cancer J

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The Affordable Care Act (ACA) included multiple provisions expected to increase cancer screening and subsequently early diagnosis of cancer. Key provisions included new coverage options for low-income adults and young adults, as well as elimination of cost-sharing for recommended preventive services across most health insurance plans. This paper reviews relevant quantitative studies published since the ACA’s passage to assess whether the goal of increasing access to preventive services has been met. Due to lags in data availability, most studies examined only a short time period post-ACA. Findings on changes in screening in the general population were mixed, though impacts were greatest among those with lower education and income, as well as groups that previously faced the highest cost-barriers to screening. Further, multiple studies found evidence of increases in early stage diagnoses for certain cancers. Thus, certain targeted populations appear to have better access to cancer screening after the ACA.

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Medicaid Coverage Expansion and Implications for Cancer Disparities

Abstract: Disparities in cancer screening that already disfavor states with high cancer rates may widen in states that have not chosen to expand Medicaid unless significant efforts are mounted to ensure their residents obtain preventive health care.

Cited by 62 publications

References 18 publications

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

Colorectal cancer screening at US community health centers: Examination of sociodemographic disparities and association with patient‐provider communication

Identifying and characterizing cancer survivors in the US primary care safety net

The ACA and Cancer Screening and Diagnosis

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