Early Medicaid Expansion Associated with Decreased Cancer Mortality

Presenting author:
Justin Michael Barnes MD, MS

By Christina Okoye, MD

Given the ongoing discussions surrounding health care legislation, it remains imperative to review the impact of recent health policy changes on relevant oncologic outcomes. With this in mind, Barnes et al. used National Center for Health Statistics (NCHS) data to evaluate the association between early Medicaid expansion (2010-2011) and cancer mortality rates. Specifically, their analysis compared early expansion states (EXP) to all other states (NEXP) with regard to cancer mortality, based on a difference-in-difference analysis adjusted for county-level covariates.

Barnes et al. noted that the overall (combined) cancer mortality rates decreased over the study period in both EXP (75.7 to 64 deaths / 100,000 people) and NEXP states (88 to 77.9 deaths per 100,000 people). When comparing across groups, a reduction of 1.3 cancer deaths per 100,000 people was seen among EXP relative to NEXP, translating to as many as 2,100 cancer deaths prevented over the entire study period (2012-2016). In a subanalysis by cancer subsite, significant differences were seen among patients with cancers of the pancreas (-0.22 deaths / 100,000 people, 95% CI [-0.38, -0.05]) and liver (-0.23 deaths / 100,000 people, 95% CI [-0.39, -0.07]), while cancers of the breast (p=0.36), cervix (p=0.52), colon (p=0.52), lung (p=0.25) and prostate (p=0.082) remained insignificant. The authors believe these results can potentially be explained by the underlying tumor biology, with the more aggressive tumors like pancreatic and liver cancer showing significant short-term mortality differences due to their short natural history. In contrast, the other cancers, which can be detected through screening, may have a longer natural history and require longer follow-up to demonstrate mortality differences.

The authors concluded that, while all states showed improvements during the study period, early Medicaid expansion was indeed associated with lower cancer mortality and adds to the body of literature that confirms health policy changes are associated with patient-level cancer outcomes. Due to methodological limitations, however, causality could not be established, and the impact of the larger main Medicaid expansion (2014) during the study period remains unclear. Investigators suggest that further research and additional follow up are needed to understand the long-term trends after Medicaid expansion and mechanisms underlying these observed differences. They suspect that the observed mortality differences are due to improvements in health care access leading up to the cancer diagnoses as well as access to cancer-directed therapies. If true, this may have substantial implications in optimizing ongoing and future Medicaid policy changes. The findings may also suggest that other recent policy changes may have a detrimental impact on cancer patients, including the presence of Medicaid work requirements that may decrease insurance rates and limited insurance policies that may not cover the full scope of cancer care. Moving forward, the investigators hope to use these and other data to design more robust future studies and help optimize legislation for cancer care affecting our populace.

Associations of Early Medicaid Expansion and Cancer Mortality was released onDemand on Wednesday, October 28, in the Science Center as part of Scientific Session (SS) 34

Published on: October 29, 2020