Study finds that states that expanded Medicaid experienced greater declines in cancer‐related deaths

Abstract

States that expanded their Medicaid programs after the Patient Protection and Affordable Care Act of 2010 took effect experienced larger declines in cancer mortality rates compared with states that did not, according to a nationwide study presented at the virtual 2020 meeting of the American Society of Clinical Oncology. Examining overall trends for US age-adjusted cancer mortality from 1999 to 2017, researchers identified a 29% decline in cancer mortality for states that expanded Medicaid, dropping from 65.1 to 46.3 per 100,000 population in that time span. Meanwhile, cancer mortality rates dropped by approximately 25%, from 69.5 to 52.3 per 100,000 population, in states that did not expand their programs. States that expanded their Medicaid programs after 2014 saw an estimated 785 fewer cancer deaths in 2017 alone, the authors note. Lead author Anna Lee, MD, MPH, who conducted the research as a radiation oncology fellow at Memorial Sloan Kettering Cancer Center in New York City but has since joined The University of Texas MD Anderson Cancer Center in Houston, points out that the study is the first to demonstrate that Medicaid expansion saved lives among individuals with cancer nationwide. When the Patient Protection and Affordable Care Act permitted states to expand Medicaid coverage for low-income individuals and those with disabilities, many of them formally did so in January 2014. As a result, states experienced large increases in Medicaid enrollment among individuals who were near the poverty level and newly eligible for the program. For the study, researchers analyzed data from the National Center for Health Statistics, establishing baseline trends from 1999 to 2017. They then compared age-adjusted rates prior to full state expansion (from 2011 to 2013) with the period after expansion (from 2015 to 2017). They did not include cancer deaths in patients aged 65 years and older because this group is eligible for Medicare. During the analysis period, 27 states plus the District of Columbia expanded Medicaid whereas 23 did not. Investigators also examined changes in subpopulations, including Black and Hispanic patients. Although the Black population experienced large improvements in mortality rates, researchers found no additional gains for this subgroup in states that expanded Medicaid. They did observe, however, that overall age-adjusted mortality was consistently worse for Black patients in states without Medicaid expansion compared with states that had adopted expansion: 58.5 versus 63.4 per 100,000 population for the Medicaid expansion states and nonexpansion states, respectively, in 2017. Meanwhile, study results indicate that Hispanic patients benefited the most from Medicaid expansion, largely because they comprise a greater percentage of the population and had 3 times the uninsured rate as White adults in states that adopted it, according to senior author Fumiko Chino, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center. Researchers plan to continue their analysis as new data become available from the National Center for Health Statistics.