PD25-02 ASSOCIATIONS OF MEDICAID EXPANSION WITH INSURANCE COVERAGE, STAGE, AND TREATMENT AMONG PATIENTS WITH GENITOURINARY MALIGNANCIES

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures II (PD25)1 Sep 2021PD25-02 ASSOCIATIONS OF MEDICAID EXPANSION WITH INSURANCE COVERAGE, STAGE, AND TREATMENT AMONG PATIENTS WITH GENITOURINARY MALIGNANCIES Katharine Michel, Aleigha Spaulding, Ahmedin Jemal, K. Robin Yabroff, Xuesong Han, and Daniel Lee Katharine MichelKatharine Michel More articles by this author , Aleigha SpauldingAleigha Spaulding More articles by this author , Ahmedin JemalAhmedin Jemal More articles by this author , K. Robin YabroffK. Robin Yabroff More articles by this author , Xuesong HanXuesong Han More articles by this author , and Daniel LeeDaniel Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002018.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Health insurance is associated with improved outcomes in cancer patients broadly. We aim to detect if insurance expansion in the form of the Affordable Care Act's Medicaid Expansion improved the insurance status, stage at diagnosis, and receipt of treatment for patients with genitourinary cancer. METHODS: We perform difference-in-differences analyses where states that expanded Medicaid are the intervention group and states that chose not to expand are the control group. We include adults aged 18-64 years with a new diagnosis of kidney, bladder or prostate cancer in the National Cancer Database from 2011-2016. The outcomes are insurance status at time of diagnosis, stage of cancer at diagnosis, and receipt of various cancer and stage specific treatments. A sub-analysis of the low income population (<138% Federal Poverty Level) is also performed. RESULTS: As compared to non-expansion states, Medicaid expansion is associated with a net decrease in uninsured rate of 1.1 percentage points (ppt) across all incomes and 4.4 ppt in the low-income population. Expansion was also associated with a significant shift towards early stage diagnosis in kidney (1.4 ppt across all incomes and 4.6 ppt in low-income) and prostate cancer (3.0 ppt in low-income) (Table 1). Finally, there was a net increase in receipt of active surveillance for low-risk prostate cancer of 4.3 ppt across incomes and 4.8 ppt among low-income patients associated with expansion (Table 2). CONCLUSIONS: Medicaid expansion is associated with decreases in uninsurance, increases in the proportion of kidney and prostate cancer diagnosed in early-stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population. Effects were concentrated in the low-income population and reinforce the importance of improving access to care to all patients with cancer. Source of Funding: This project was supported by grant K12HS026372 from the Agency for Healthcare Research and Quality © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e431-e431 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katharine Michel More articles by this author Aleigha Spaulding More articles by this author Ahmedin Jemal More articles by this author K. Robin Yabroff More articles by this author Xuesong Han More articles by this author Daniel Lee More articles by this author Expand All Advertisement Loading ...