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Expanding Medicaid Linked to Fewer Women Diagnosed With Later-Stage Breast Cancer

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Expanded Medicaid coverage through the Affordable Care Act was linked to fewer women diagnosed with later-stage breast cancer, as well as a reduction in the number of women diagnosed with breast cancer with no insurance.

The research was published online on July 1, 2020, by JAMA Surgery. Read the abstract of “Association of Medicaid Expansion Under the Affordable Care Act With Breast Cancer Stage at Diagnosis.”

About Medicaid expansion and the Affordable Care Act

Passed in 2010, the Affordable Care Act had a goal to dramatically reduce the number of people with no insurance. One requirement of the act was that nearly all Americans had to have health insurance.

Medicaid is the United States’ health insurance program for people with low income. Medicaid is administered by individual states. The Affordable Care Act expanded Medicaid coverage to people who make 138% of the federal poverty level ($17,236 per year in 2019). The June 2012 U.S. Supreme Court decision in the case challenging the constitutionality of the Affordable Care Act made the Medicaid expansion part of the act optional for states. States could start expanding Medicaid in 2014.

As of Feb. 19, 2020, 37 states and Washington, DC, have expanded Medicaid.

In practice, expanding Medicaid means that more people in that state will be eligible for low-cost health insurance.

About the study

To do the study, the researchers looked at information from the National Cancer Database, a collection of information on cancer cases from more than 1,500 Commission on Care-accredited facilities in the United States. The database is sponsored by the American College of Surgeons and the American Cancer Society. The data represent more than 70% of newly diagnosed cancer cases in the country.

The researchers looked at information on 1,796,902 women diagnosed with breast cancer from 2007 to 2016 in 31 states that expanded Medicaid coverage and 14 states that did not expand Medicaid coverage.

The women had private insurance, Medicare, Medicaid, or no insurance.

The researchers looked for links between breast cancer stage at diagnosis and race/ethnicity, age, and insurance status. The researchers also compared the years before Medicaid expansion — 2012-2013 — to the years after Medicaid expansion — 2015-2016 — to see how Medicaid expansion had affected any links.

Between 2012 and 2016, 4% of the women had no insurance or Medicaid.

In the states that expanded Medicaid, the rate of women diagnosed with breast cancer with no insurance dropped from 22.6% to 13.5%. This difference was statistically significant, which means that it was likely due to the Medicaid expansion and not just because of chance.

In states that didn’t expand Medicaid, the rate of women diagnosed with breast cancer with no insurance dropped from 36.5% to 35.6%. This drop of 0.9% was not statistically significant, which means that it could have been due to chance.

In states that expanded Medicaid coverage, the rate of women diagnosed with more advanced-stage breast cancer dropped from 21.8% to 19.3%, which also was statistically significant.

In states that didn’t expand Medicaid, the rate of women diagnosed with more advanced-stage breast cancer dropped from 24.2% to 23.5%, a difference that was not statistically significant and so could have been due to chance.

The researchers also found that the change in women diagnosed with more advanced-stage disease at diagnosis was particularly notable in Black women, dropping from 24.6% to 21.6% in states that expanded Medicaid, and actually increasing from 27% to 27.5% in states that didn’t expand Medicaid.

“This result was particularly striking since Black women generally present with more aggressive cancer and decreased survival rates,” Tristen Park, M.D., Yale School of Medicine assistant professor of surgery (oncology) and senior author of the paper, said in a statement. “Again, no significant changes were observed in diagnosis stage among this population in non-expansion states.”

More younger women also were diagnosed with earlier-stage breast cancer in states that expanded Medicaid compared to states that didn’t expand Medicaid.

Among women younger than 50, the rate of women diagnosed with more advanced-stage breast cancer dropped from 23% to 21% in states that expanded Medicaid. In states that didn’t expand Medicaid, the rate stayed the same at 26%.

“If the cancer is diagnosed early, generally treatment is definitive and women have good overall survival,” Justin Le Blanc, M.D., surgical resident at the Yale Cancer Center and first author of the study, said in a statement. “It's important to get women health care access early. And when patients have access to health care, they're more likely to utilize it.”

What this means for you

The results of this study echo the findings of earlier studies showing that women with either no insurance or Medicaid insurance were more likely to be diagnosed with more advanced-stage breast cancer. As this study strongly suggests, expanding Medicaid coverage means that more women are diagnosed with breast cancer at an earlier stage, when the cancer is likely to be more treatable.

All women — no matter their age, ethnicity, economic status, or insurance status — deserve the best breast healthcare possible. Differences in care that affect cancer outcomes, such as screening, access to care, and quality and consistency of care, should be eliminated.

Screening is a good place to start. Most doctors agree that breast cancer that is diagnosed early is typically easier to treat and offers the best survival chances. Regular screening for breast cancer, including annual mammograms and breast exams by a medical professional, is important for everyone. Paying for healthcare can be difficult, especially if you have a limited income and no or inadequate health insurance or are covered only by Medicaid in a state that has not expanded Medicaid. But if you're older than 40, skipping regular mammograms is not an option. Stick with the screening plan you and your doctor decide is best for you. If scheduling problems or cost concerns are stopping you from getting a mammogram, talk to your doctor, a hospital social worker, or a staff member at a mammogram center. Ask about free mammogram programs and healthcare services in your area. It's your health and your future, and you deserve the best care possible.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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