ASCO calls for Medicaid reform to improve cancer care for beneficiaries.

Abstract

State Medicaid programs must strengthen and expand access to high-quality cancer care for patients with low incomes, according toanewpolicy statement from the American Society of Clinical Oncology (ASCO). About a fifth of the US population, or 67.9 million individuals, is enrolled in Medicaid, and an estimated 2.1 million of them either have cancer or have previously been treated for it, according to the ASCO statement (http://bit.ly/1z64gyS). “The program’s shortcomings mean that major gains in cancer treatment and prevention are still too far out of reach for many Americans,” ASCO president Peter Yu, MD, a medical oncologist and hematologist and director of cancer research at Palo Alto Medical Foundation, said in November during a webcast in which he and 2 of the policy statement authors discussed it with journalists. Published studies about the effect of Medicaid coverage on cancer diagnosis, treatment, and outcomes have been mixed, ASCO says. Some research has shown that, compared with privately insured individuals, Medicaid beneficiaries were more likely to be diagnosed with cancer at stage III or stage IV instead of stage I. Medicaid beneficiaries are approximately 3 times more likely to be diagnosed at a later stage with cancers that can be diagnosed early through appropriate screening, such as breast cancer and melanoma, according to ASCO, citing information from an analysis of data from the National Cancer Database (Halpern MT et al. Lancet Oncol. 2008;9:222-231). “In somegeographic areas,wehavepatients who are screened but have difficulty accessing treatment,” Shelley Fuld Nasso, MPP, chief executive officer of the National Coalition for Cancer Survivorship, said during the ASCOwebcast. After accounting for potential confounders, however, some studies have reported similar treatment patterns and outcomesamongpatientswithcancerwhohad Medicaid andprivate insurance,while uninsuredpatientswere significantlymore likely to be diagnosed with advanced cancer, according to ASCO. ASCO is calling on every state to expandMedicaidorprovidecomparable alternatives. Under the Affordable Care Act (ACA), the federal government is paying states the entire cost for 3 years—2014 through 2016—of expandingMedicaid coveragetoall adultsyoungerthan65yearswho earnup to 133%of the federal poverty level. To be eligible for Medicaid, an individual couldmake up to $16 105 a year, a family of