Abstract
Few investigations have explored the potential impact of the Affordable Care Act on health disparity outcomes in states that chose to forgo Medicaid expansion. Filling this evidence gap is pressing as Congress grapples with controversial healthcare legislation that could phase out Medicaid expansion. Colorectal cancer (CRC) is a commonly diagnosed, preventable cancer in the US that disproportionately burdens African American men and has substantial potential to be impacted by improved healthcare insurance coverage. Our objective was to estimate the impact of the Affordable Care Act (increasing insurance through health exchanges alone or with Medicaid expansion) on colorectal cancer outcomes and economic costs among African American and White males in North Carolina (NC), a state that did not expand Medicaid. We used an individual-based simulation model to estimate the impact of ACA (increasing insurance through health exchanges alone or with Medicaid expansion) on three CRC outcomes (screening, stage-specific incidence, and deaths) and economic costs among African American and White males in NC who were age-eligible for screening (between ages 50 and 75) during the study period, years of 2013–2023. Health exchanges and Medicaid expansion improved simulated CRC outcomes overall, though the impact was more substantial among AAs. Relative to health exchanges alone, Medicaid expansion would prevent between 7.1 to 25.5 CRC cases and 4.1 to 16.4 per 100,000 CRC cases among AA and White males, respectively. Our findings suggest policies that expanding affordable, quality healthcare coverage could have a demonstrable, cost-saving impact while reducing cancer disparities.
Highlights
IntroductionPublic concern has been mounting about the potential impacts of an ACA repeal on populations at risk for health and healthcare disparities
Our nation is embattled over the future of its healthcare system
The control and all ACA policy scenarios resulted in an increase over time in the percent up-to-date with Colorectal cancer (CRC) screening among both White and African American males (Fig 1)
Summary
Public concern has been mounting about the potential impacts of an ACA repeal on populations at risk for health and healthcare disparities. In addition to expanding private healthcare coverage, ACA legislation afforded states a historic opportunity to expand Medicaid to childless adults with incomes at or below 138 percent of the federal poverty level (FPL) [1]. Expanded eligibility is having a disproportionately positive impact on adult men compared to women because men have historically been less often Medicaid-eligible [1]. Medicaid expansion states are experiencing post-ACA gains in insurance coverage among newly eligible childless men [3]. In the setting of expanded Medicaid eligibility, the probability of insurance coverage among men increased by 14.2 percentage points [3]. Coverage gains are most pronounced among racial/ethnic minority men (e.g., non-Hispanic Blacks or African Americans)—populations with well-documented racial disparities in conditions amenable to treatment upon early detection [4, 5]
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