May 18, 2020 / 4:48 PM / 13 days ago

Medicaid expansion followed by bigger drop in cancer-related deaths

NEW YORK (Reuters Health) - States that expanded Medicaid under the Affordable Care Act (ACA) saw greater declines in cancer-related deaths than states that did not, according to the first nationwide study of its kind.

“This is the first study to show the benefit of Medicaid expansion on cancer death rates on a national scale. We now have evidence that Medicaid expansion has saved the lives of many people with cancer across the United States,” lead author Dr. Anna Lee of Memorial Sloan Kettering (MSK) Cancer Center (MSK) in New York City said in a statement.

She reported the findings May 13 at the American Society of Clinical Oncology (ASCO) virtual scientific sessions.

“This study provides needed data to understand the effects of Medicaid expansion on cancer care. Better access to quality cancer care, in this case through state expansion of Medicaid, leads to fewer cancer deaths,” ASCO Chief Medical Officer Dr. Richard L. Schilsky said in the statement.

Twenty million people gained insurance under the ACA of 2010. By 2015, 27 states and the District of Columbia had expanded Medicaid while 23 states did not.

Based on federal data, cancer mortality has decreased over time for all populations, with additional benefit in states that expanded Medicaid after 2014. Specifically, cancer mortality fell 29% in states that expanded Medicaid and by 25% in states that did not, Dr. Lee reported.

The additional mortality benefit for states that expanded Medicaid amounted to an estimated 785 fewer cancer deaths in 2017. “It is estimated that an additional 589 cancer deaths could have been prevented if non-expanded states had expanded Medicaid,” Dr. Lee said.

Hispanic populations reaped the greatest cancer mortality benefit after Medicaid expansion.

“There is a greater Hispanic population in states that have adopted Medicaid expansion, and they have almost three times the un-insurance rate as white adults,” senior author Dr. Fumiko Chino, also at MSK, said in the statement. “Our research shows that Hispanic patients with cancer may have benefited the most because they had the most to gain.”

“Black patients did not appear to reap the same mortality decrease, although this may be due to continued large mortality gains over time,” Dr. Lee explained in her presentation.

“Further study is needed to understand how national programs and policies can continue to improve access to care and decrease healthcare disparities,” Dr. Lee concluded.

Dr. Deborah Marshall of The Tisch Cancer Institute at Mount Sinai in New York City, who was not involved in the research, told Reuters Health by email, "These data add to the growing body of evidence that Medicaid expansion improves access to care and health outcomes, and in particular, the study addresses an important gap in our understanding of whether Medicaid expansion is associated with cancer mortality. Further validation is needed to understand the underlying causes of this association." SOURCE: American Society of Clinical Oncology (ASCO), presented May 13, 2020

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