A study by Quyen D. Chu, MD, MBA, FACS, and colleagues published in the journal Cancer investigated how expansion of the Medicaid provision in the the Patient Protection and Affordable Care Act (ACA) affected breast cancer care in Louisiana. The state is the third poorest in the country and has one of the lowest median incomes, with nearly 30% of its citizens living in rural areas. The study found that the rate of uninsured patients decreased, and rates of early-stage diagnosis and access to treatment increased.

Quyen D. Chu, MD, MBA, FACS

Passed into law in 2010, but not enacted until 2014, the ACA allowed states to adopt Medicaid expansion, providing health care for millions of low-income Americans. To date, 38 states plus the District of Columbia, have expanded Medicaid coverage through the ACA, and a growing body of research has shown that Medicaid expansion has improved individuals’ access to care, health outcomes, and financial security.

The study results highlight the positive impact ACA expansion has had on patients, especially for patients with breast cancer and historically limited access to care, including younger adults and patients with low socioeconomic status.

Study Methodology

The researchers analyzed data from the Louisiana Tumor Registry on 14,640 women in Louisiana diagnosed with stage 0 to stage IV breast cancer between 2012 and 2018. The women ranged in age between 20 and 64 years. Sociodemographic variables, including age, race, urban vs rural residence, socioeconomic status, insurance status, educational level, stage of disease at diagnosis, and patients’ Deyo-Charlson Comorbidity Index, were evaluated in the analysis.

The study period was divided into two groups: before ACA expansion (January 1, 2012, to May 31, 2016) and after ACA expansion (June 1, 2016, to December 31, 2018). The chi-square test and multivariable logistic regression models were used to assess the impact of ACA expansion in the state.

Study Findings

The researchers found that after the ACA expansion, the rate of uninsured patients decreased from 5.4% to 3.0% (P < .0001), and the rate of Medicaid recipients increased from 11.6% to 17.7% (P < .0001). The diagnosis of stage I breast cancer increased from 36.8% to 44.7% (P < .0001), whereas the diagnosis of stage III breast cancer decreased from 10.7% to 8.5% (P < .0001). The receipt of radiotherapy after breast-conserving surgery increased from 81.2% to 84.0% (P = .0035), and the receipt of radiotherapy within 90 days increased from 57.2% to 61.7% (P  = .0012).

After adjustment for sociodemographic and clinical variables, the models demonstrated that ACA expansion decreased the uninsured rate by 48% (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.43-0.63) , increased the diagnosis of early-stage disease (stage 0 to stage II) by 27% (OR = 1.27, 95% CI = 1.15–1.41), increased receipt of radiotherapy after breast-conserving surgery by 19% (OR = 1.19, 95% CI = 1.03–1.37), and reduced the delay of receipt of radiotherapy by 16% (OR = 0.84, 95% CI = 0.74–0.95).

“The results of the current study have highlighted the positive impact of ACA expansion, especially for populations of patients with breast cancer with historically limited access to care, including younger adults, low-income groups, and those of low socioeconomic status. Further longitudinal studies will be needed to assess whether ACA expansion decreases breast cancer mortality for the residents of Louisiana,” concluded the study authors.

Dr. Chu, of the Division of Surgical Oncology in the Department of Surgery at Louisiana State University Health Sciences Center in Shreveport, is the corresponding author of this study.

Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.