States where Medicaid was expanded under the Affordable Care Act have seen a measurable increase in the early detection of cancer and reduced late-stage cancer incidence, according to the results of a new study published in the current issue of the American Journal of Preventive Medicine. The study, “Early- and Late-Stage Cancer Diagnosis Under 3 Years of Medicaid Expansion,” was conducted by researchers from American University’s School of Public Affairs and the University of Pittsburgh’s Medical School and School of Public Health.
Cancer is the second-leading cause of death in the U.S., with nearly 610,000 fatalities recorded in 2018. Cancer screenings can increase early detection, but lack of health insurance limits access to care.
“Early-stage diagnosis of cancer is a key public health priority because earlier detection leads to higher survival rates,” said Aparna Soni, assistant professor at American University’s School of Public Affairs and one of the authors of the study. “At a time when 28 million Americans remain uninsured, this study provides evidence that expanding insurance coverage is a potential avenue to improve cancer outcomes.”
Previous studies found that Medicaid expansions reduced cost barriers to care and increased cancer screening. This research is a population-based study of non-elderly adults was conducted in 732 counties based on the 2010−2016 Surveillance, Epidemiology, and End Results Program cancer registry data. The researchers compared annual changes in county-level rates of cancer diagnoses in states that expanded Medicaid with those that did not. Since the ACA was adopted in 2014, 39 states (including D.C.) expanded eligibility for Medicaid to all low-income adults, compared to 12 states that declined to expand their programs.
“We find that Medicaid expansions increased early-stage cancer diagnosis in the first year of expansion, which is indicative of increased access to cancer screenings and other preventive care,” said Aparna Soni, assistant professor at American University’s School of Public Affairs and one of the study’s authors. “There was also suggestive evidence of reductions in late-stage diagnosis in the third year of Medicaid expansion, highlighting the potential role of public health insurance in improving cancer outcomes among adults below age 65.”
The authors found that Medicaid expansion was associated with a 9% increase in early-stage cancer diagnosis in its first year, but effects dissipated in the second and third years following expansion. Researchers believe that this is a response to pent-up demand for screening and diagnostic services immediately after expansion.
Before 2014, the uninsured rate exceeded 20% for non-elderly adults, with low-income persons most likely to be uninsured. Under the ACA, Medicaid enrollment increased in participating states by nearly 14 million people between 2014 and 2016.