Medicaid Is Under Threat: Why That Matters for Breast Cancer Care

Chances are, you’ve been on Medicaid at some point in your life or know someone who has. It covers more than 72 million adults and is the largest public health insurance program in the U.S. It’s also popular among Americans of all political parties. In a recent poll by the health policy organization KFF, more than three-fourths of Americans (77%) said they view Medicaid favorably.

But on July 1, the Senate narrowly passed a budget bill that could lead to more than $1 trillion in cuts to federal spending on Medicaid over 10 years. Those funds would be used to help offset $4.5 trillion in tax cuts to the wealthiest Americans. Due to the cuts to Medicaid and changes to the ACA Marketplaces, the number of Americans without health insurance would increase by about 17 million by 2034. 

The bill still needs to be passed by the House before the President can sign it into law. The final version may not include such large cuts to Medicaid. But it seems likely that funding for the program will be drastically reduced, which could keep millions of Americans from getting the care they need. 

For many people with a breast cancer diagnosis — or those hoping to avoid one — losing Medicaid coverage could mean losing access to regular mammograms and other screening tests, breast cancer treatment and follow-up care, and even primary care to stay healthy and lower breast cancer and recurrence risk.

Medicaid is a government program that provides free or low-cost health insurance to people with low incomes or disabilities. 

The program is funded jointly by the federal government and the states. The federal government contributes most of the money (about 69% in 2023), but each state has its own Medicaid program and eligibility guidelines. For that reason, Medicaid can look very different depending on what state you’re in. 

“Even people who are enrolled in Medicaid often don’t realize they are,” says Joanna Doran, a cancer rights attorney and CEO of Triage Cancer. That’s partly because state Medicaid programs can go by many different names and can offer plans run by private insurance companies, explains Doran. For example, Medicaid in Washington state is called Apple Health; in Tennessee, it’s TennCare; in Vermont, Green Mountain Care.

Most Medicaid plans cover basic screening for and treatment of breast cancer, and care for other medical needs (such as primary care, dental care, vision services, and prescriptions). Not all of those benefits are offered by every plan in every state, though. 

Medicaid provides affordable or free coverage for Americans who can’t easily get other health insurance, and is more common than most people think, with high percentages of people across the country — in both Republican and Democratic districts — enrolled. 

“Medicaid covers 1 in 4 people in the U.S. and most people don’t realize that,” says Doran. That, of course, includes people who are at risk for, or diagnosed with, breast cancer.   

People with breast cancer commonly access Medicaid in a few situations:   

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  they meet the household income requirements for Medicaid and are looking for an insurance plan (in some cases, they might have been uninsured or lost their employer-provided or Health Insurance Marketplace plan, including right after a breast cancer diagnosis) 

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  they have both Medicare and Medicaid, with Medicaid covering out-of-pocket costs that Medicare does not

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  they have a disability (such as difficulties with hearing, vision, or mental functioning)

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  they receive Supplemental Security Income (SSI), which is common among people with metastatic breast cancer 

People get Medicaid through a number of programs administered through their individual state. One form of Medicaid that every state offers, called the Breast and Cervical Cancer Treatment Program, is specifically for people with low incomes who are uninsured or underinsured, under the age of 65, and have been diagnosed with breast cancer or a precancerous condition of the breast.

Since many people who are at risk for or diagnosed with breast cancer rely on Medicaid for their coverage, reducing federal funding for the program will make breast cancer more dangerous. 

Research has shown that better access to Medicaid improves breast cancer outcomes. Since 2014, 41 states have expanded their Medicaid programs to more of their residents. Compared to people in states that didn’t expand access to Medicaid, people in states that did were more likely to:

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  have breast cancer detected at an earlier stage, when it’s easier to treat 

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  receive timely treatment for breast cancer that follows medical guidelines   

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  have a higher chance of surviving breast cancer (as measured by two-year overall survival rates)

Some research also shows that expanding access to Medicaid has helped reduce the gaps in care that affect certain groups. For example, Black and Hispanic people with breast cancer experienced fewer delays in starting chemo after states expanded access to Medicaid. Also, young adults (under age 40) with breast cancer had better survival rates in states that expanded Medicaid.  

“It’s clear that the states that expanded Medicaid coverage under the Affordable Care Act (ACA) had better cancer outcomes. More patients could access cancer care,” says Kathy Miller, MD, professor of oncology and of medicine and associate director of clinical research at the IU Simon Cancer Center in Indianapolis, Indiana.

“Before Medicaid expansion, it used to be much more common in my practice to see people who were uninsured and delaying getting breast cancer care until they were very sick, because they didn’t want to put a financial burden on their family,” she says.

That remains to be seen. But these are a few of the ways Republicans in Congress have discussed cutting the federal government’s spending on Medicaid:

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  reducing the federal government's share of costs for enrollees who get access to Medicaid through ACA Medicaid expansion policies  

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  imposing new caps on the total amount of federal funding for Medicaid that each state can receive each year

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  requiring that certain Medicaid enrollees prove they are working 

These changes could force states to trim their Medicaid programs by, for example, covering fewer medical services; eliminating coverage for some people; and/or cutting the rates they pay to doctors, hospitals, and nursing homes. Rural and safety-net hospitals and community health centers would be at particular risk, as they rely more on Medicaid revenue.

Members of Congress will be voting on final versions of the budget bill in July, so it’s a great time to tell your representative how you feel. Clearly state your interest in preserving funding for Medicaid and — if you feel comfortable — share your story. Remind them that you live in the district they were elected to represent and that you’ll remember their votes come election time. 

The site 5calls.org makes it easy to find the phone numbers for your members of Congress and provides a script you can use if that feels easier.

The American Cancer Society Cancer Action Network (ACS CAN) has an online form you can fill out to send a message now to your members of Congress urging them to oppose cuts to Medicaid. You can personalize your message with your cancer story or explain why this issue matters to you. 

ACS CAN also has an online petition you can sign to ask members of Congress to protect Medicaid funding.