According to yearly estimates, cancer remains the leading cause of death for working-age Americans. Having health insurance coverage is a strong determinant of access to cancer care and survival among newly diagnosed cancer patients in the United States.  In contrast, lack of health insurance coverage is one of the strongest predictors of poor cancer outcomes in the United States. [1][2][3]

And while the expansion of Medicaid income eligibility under the Affordable Care Act (ACA) has increased insurance coverage for working-age adults, a new study led by researchers from the American Cancer Society (ACS) confirms substantial state variations in health insurance coverage. [4]

These findings come despite a significant increase over the past decade in insurance coverage under the Affordable Care Act, which increases coverage options for working-age adults.

The research is published on January 11, 2024 in the journal Health Affairs Scholar, a journal of emerging and global health policy. [5]

“Having health insurance coverage is crucial to ensure timely access to quality cancer treatment and survivorship care,” said Xuesong Han, Ph.D., scientific director, health services research at the American Cancer Society and senior author of the study.

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“The findings reinforce the importance of the expansion of Medicaid income eligibility under the Affordable Care Act, playing a big role in access to care and helping to save lives,” Han added.

Using data from the Cancer Incidence in North America (CiNA) 2010-2019, researchers identified 6,432,117 incident cancer cases with known insurance status diagnosed at 18-64 years of age from 49 population-based state registries. Considerable variation in Medicaid coverage and uninsured rate exists across states, especially by Medicaid expansion status.

Increase in Medicare coverage
The results showed among expansion states, Medicaid coverage increased from 14.1% in 2010 to 19.9% in 2019; while the Medicaid coverage rate remained lower at 12.5% in non-expansion states. The uninsured rate decreased from 4.9% to 2.1% in expansion states; while in non-expansion states, the uninsured rate decreased slightly from 9.5% to 8.1%. In 2019, 111,393 cancer cases (16.9%) had Medicaid coverage at diagnosis and 48,357 (4.4%) were uninsured.

“This study is further proof that expanding Medicaid increases access to comprehensive health insurance and we know that alone can increase the chances that cancer is diagnosed early which in turn augments the likelihood that someone survives the disease. In short, expanding this health insurance program is saving lives,” said Lisa Lacasse, president of ACS CAN.

“ACS CAN has been a long-time advocate for Medicaid expansion to reduce the cancer burden and continues to work tirelessly in the 10 states that have not yet increased their Medicaid program eligibility.”

“These study estimates also suggest that many patients with cancer may face challenges with care access and continuity, especially following the unwinding of COVID-19 pandemic protections for Medicaid coverage,” added Xin Hu, Ph.D., MSPH, an ACS fellow/ assistant professor in the department of public health sciences at the University of Virginia School of Medicine, and lead author of the study.

“State cancer prevention and control efforts are needed to mitigate cancer care disparities among vulnerable populations,” Hu concluded.

Reference
[1] Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022 Jan;72(1):7-33. doi: 10.3322/caac.21708. Epub 2022 Jan 12. PMID: 35020204.
[2] Yabroff KR, Reeder-Hayes K, Zhao J, Halpern MT, Lopez AM, Bernal-Mizrachi L, Collier AB, Neuner J, Phillips J, Blackstock W, Patel M. Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research. J Natl Cancer Inst. 2020 Jul 1;112(7):671-687. doi: 10.1093/jnci/djaa048. PMID: 32337585; PMCID: PMC7357319.
[3] Institute of Medicine. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Washington, DC: The National Academies Press; 2013.
[4] Ermer T, Walters SL, Canavan ME, Salazar MC, Li AX, Doonan M, Boffa DJ. Understanding the Implications of Medicaid Expansion for Cancer Care in the US: A Review. JAMA Oncol. 2022 Jan 1;8(1):139-148. doi: 10.1001/jamaoncol.2021.4323. PMID: 34762101.
[5] Xin Hu, Nuo Nova Yang, Qinjin Fan, K Robin Yabroff, Xuesong Han, Health insurance coverage among incident cancer cases from population-based cancer registries in 49 US states, 2010–2019, Health Affairs Scholar, Volume 2, Issue 1, January 2024, qxad083, DOI 10.1093/haschl/qxad083 [Article]

Featured image Licensed under the Unsplash+ License. Used with permission.

 

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