ASTRO 2017: Uninsured Patients With Cancer Saw Increased Coverage for Care Following Medicaid Expansion

Key Points

  • In expanded states, the uninsured rate declined a relative 52%, from 4.4% to 2.1%, while Medicaid enrollment rose from 15.2% to 18.0%.
  • Race was associated with coverage changes in nonexpansion states only. In expansion states, coverage increased regardless of race; uninsured rates dropped by a relative 56% for white patients, from 4.3% to 1.9%, and 50% for black patients, from 6.0% to 3.0%. Uninsured rates dropped by 9% for white patients in nonexpansion states, from 7.8% to 7.1%, while uninsured rates rose by 7% for black patients, from 9.9% to 10.6%.
  • Uninsured rates in expansion states decreased by 46% for patients who lived low-poverty areas vs 60% for those who lived in high-poverty areas. In nonexpansion states, conversely, only patients in less-impoverished areas experienced an increase in coverage, as the uninsured rate dropped by 27% in low-poverty areas but rose by a relative 2% in high-poverty areas.

A new study found that Medicaid expansion enacted as part of the Patient Protection and Affordable Care Act (ACA) improved coverage for care for patients with cancer receiving radiation therapy and potentially decreased health-care disparities. Analysis of more than 197,000 patient records from one of the nation’s largest cancer registries found that the uninsured rate for these vulnerable patients dropped by half in states that fully expanded their Medicaid programs. These findings were presented by Chino et al at the American Society for Radiation Oncology’s (ASTRO’s) 59th Annual Meeting.

“Uninsured cancer patients are more likely to go without needed care and treatment, such as radiation therapy or surgery to remove tumors,” said Fumiko Chino, MD, lead author of the study and a radiation oncology resident at Duke University School of Medicine. “We conducted a study looking at insurance patterns before and after Medicaid expansion and found that uninsurance rates dropped significantly following expansion. The program appears to have improved access and decreased health-care disparities in cancer patients receiving radiation therapy, with the greatest benefits seen among vulnerable individuals living in the highest poverty areas.”

Major Findings

Findings are based on an analysis of 197,290 records from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database, including all patients aged 18 to 64 (median age, 55) who were newly diagnosed with cancer between 2011 and 2014 and received radiation therapy as part of their treatment. Researchers compared insurance rates between patients in states that fully expanded their Medicaid programs under the ACA with those in states that did not expand their Medicaid programs. Nearly three-fourths (73%) of the patients lived in states with fully expanded Medicaid programs.

The number of uninsured cancer patients dropped in both states with Medicaid expansion and those without Medicaid expansion from 2011 to 2014, but expansion states experienced a steeper decline. In expansion states, the uninsured rate declined a relative 52%, from 4.4% to 2.1%, while Medicaid enrollment rose from 15.2% to 18.0% (P < .0001). In nonexpansion states, the uninsured rate dropped a relative 5% (from 8.4% to 8.0%), with an increase in non-Medicaid insurance (from 75.7% to 77.1%) and decrease in Medicaid enrollment (from 15.9% to 14.9%; P < .0001).

Race was associated with coverage changes in nonexpansion states only. In expansion states, coverage increased regardless of race; uninsured rates dropped by a relative 56% for white patients, from 4.3% to 1.9%, and 50% for black patients, from 6.0% to 3.0% (both P < .0001). In nonexpansion states, however, only white patients experienced an increase in coverage status. Uninsured rates dropped by 9% for white patients in nonexpansion states, from 7.8% to 7.1% (P < .0001), whereas uninsured rates rose by 7% for black patients, from 9.9% to 10.6%, although the difference for black patients was not statistically significant (P = .37).

The poverty level where a patient lived similarly influenced coverage changes in nonexpansion states only. Uninsured rates in expansion states decreased by 46% for patients who lived low-poverty areas (from 3.9% to 1.8%, P < .0001) vs 60% for those who lived in high-poverty areas (from 4.5% to 1.8%, P < .0001). In nonexpansion states, conversely, only patients in less-impoverished areas experienced an increase in coverage, as the uninsured rate dropped by 27% in low-poverty areas (from 4.8% to 3.5%, P = .04) but rose by a relative 2% in high-poverty areas (from 10.9% to 11.1%, P = .17).

“This study is part of a developing body of research to quantify health-care delivery changes under the ACA. The debate over health-care reform is ongoing; our findings indicate that Medicaid expansion was effective at decreasing disparities and improving access to care for cancer patients receiving radiation. We now are assessing if these insurance changes translate to differences in patient survival,” said Dr. Chino.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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