Investigators have uncovered substantial state variations in health insurance coverage among U.S. patients newly diagnosed with cancer, according to a recent study published by Hu et al in Health Affairs Scholar.
Background
Over the past decade, health insurance coverage—which has been found to be a strong determinant of access to cancer care and survival—has significantly increased among working-age adults under the Affordable Care Act. However, considerable variation in Medicaid coverage and the uninsured rate exists across states—especially by Medicaid expansion status.
“Having health insurance coverage is crucial to ensure timely access to quality cancer treatment and survivorship care,” explained senior study author Xuesong Han, PhD, Scientific Director of Health Services Research at the American Cancer Society. “The findings reinforce the importance of the expansion of Medicaid income eligibility under the Affordable Care Act, playing a big role in access to care and helping to save lives,” she emphasized.
Study Methods and Results
In the recent study, the investigators used the 2010 to 2019 Cancer Incidence in North America database to identify 6.4 million patients aged 18 to 64 with cancer and known insurance status from 49 population-based state registries. The investigators found that Medicaid coverage increased from 14.1% in 2010 to 19.9% in 2019 in Medicaid expansion states, whereas the Medicaid coverage rate remained lower at 12.5% in Medicaid nonexpansion states. Additionally, compared with Medicaid nonexpansion states, in Medicaid expansion states, the uninsured rate decreased from 4.9% vs 9.5% in 2010 to 2.1% vs 8.1% in 2019.
The investigators discovered that 16.9% (n = 111,393) of cancer cases were covered by Medicaid at diagnosis in 2019 and 4.4% (n = 48,357) of cases were uninsured.
Conclusions
“This study is further proof that expanding Medicaid increases access to comprehensive health insurance, and we know that alone can increase the chances that cancer is diagnosed early—which in turn augments the likelihood that [a patient] survives the disease. In short, expanding this health insurance program is saving lives,” underscored Lisa Lacasse, MBA, President of the American Cancer Society Cancer Action Network (ACS CAN). “ACS CAN has been a long-time advocate for Medicaid expansion to reduce the cancer burden and continues to work tirelessly in the 10 states that have not yet increased their Medicaid program eligibility,” she added.
“These study estimates also suggest that many patients with cancer may face challenges with care access and continuity, especially following the unwinding of COVID-19 pandemic protections for Medicaid coverage,” stressed lead study author Xin Hu, MSc, Assistant Professor in the Department of Public Health Services at the University of Virginia School of Medicine and a research fellow at the American Cancer Society. “State cancer prevention and control efforts are needed to mitigate cancer care disparities among vulnerable populations,” she concluded.
Disclosure: For full disclosures of the study authors, visit academic.oup.com.
