In states that have expanded Medicaid availability as part of the Affordable Care Act (ACA), mortality rates for three major types of cancer are significantly lower than in states that have not expanded Medicaid availability, according to a recent study by researchers at Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard University.1 Data from the study, published in JAMA Network Open, suggest the improvement in mortality results from cancers being diagnosed at an earlier stage in states with Medicaid expansion.
“It’s been thought that Medicaid expansion might improve mortality by fostering earlier detection, earlier stage of diagnosis, and improved access to treatment,” according to Miranda Lam, MD, MBA, of Dana-Farber, Brigham and Women’s Hospital, and Harvard T.H. Chan School of Public Health. “On the other hand, it could worsen mortality by creating an influx of newly covered patients that strains hospitals’ resources.”
Miranda Lam, MD, MBA
FOR THE STUDY, researchers used the National Cancer Database to track 523,802 patients across the country who were newly diagnosed with breast, lung, or colorectal cancer from 2012 through 2015. They compared mortality rates for these patients in states that expanded their Medicaid programs and those that did not. (A totoal of 24 states and the District of Columbia expanded their programs on January 1, 2014.)
“We found that Medicaid expansion was associated with a significant decrease in mortality compared to states without such expansion,” Dr. Lam remarked. The expansion group had a 2% decline in hazard of death from the pre- to the post-
expansion period. The nonexpansion group, by contrast, showed no change in mortality. If the 2% reduction was achieved in all states with expanded Medicaid, then among the approximately 69,000 patients diagnosed with cancer in those states, 1,384 lives would be saved yearly, researchers calculated.
The biggest difference between the two groups was in patients whose cancers had not reached a metastatic stage. When investigators adjusted for the stage at which cancers were diagnosed, improvements in mortality were no longer seen—whether between expansion and nonexpansion states or between the pre-expansion and post-expansion periods. This suggests that the decline in mortality associated with Medicaid expansion is a byproduct of diagnosing cancer at an earlier stage.