Public Payers News

Medicaid Expansion May Close Racial Health Disparities, Care Gaps

Following Medicaid expansion health disparities nearly entirely closed, suggesting that insurance coverage could drive health equity.

medicaid expansion

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By Sara Heath

- Medicaid expansion may have closed racial health disparities in timely cancer care access, according to a group of researchers from the Yale Cancer Center.

The research, presented recently at the American Society of Clinical Oncology (ASCO) 2019 annual meeting, leveraged over 30,000 medical records stored by Flat Iron Health, an EHR company focusing on oncology care and which funded the study.

Health disparities have long been pervasive, especially when comparing patients across racial and socioeconomic lines. Health disparities refer to trends in which certain groups of patients do not have the same access to or availability of healthcare services, which often lead to different health outcomes.

Prior to Medicaid expansion, black patients faced health disparities as they relate to cancer care access.

An analysis of medical records for adult patients diagnosed with advanced or metastatic breast cancer, NSCLC, urothelial cancer, gastric cancer, colorectal cancer, renal cell cancer, prostate cancer, and melanoma, revealed that black patients did not receive timely access to cancer treatment following diagnosis as often as their white peers did.

Specifically, black adults diagnosed with advanced or metastatic cancer were 4.8 percentage points less likely to receive treatment within 30 days of diagnosis compared to white adult patients.

Following Medicaid expansion, which was allowed under the Affordable Care Act (ACA), those disparities went away, the researchers observed. The percentage of black patients receiving timely treatment increased by 6.1 percentage points, from 43.5 percent to 49.6 percent.

Although the study does not offer conclusive proof – the researchers did not investigate the cause of the health disparity closures, but instead only observed trends – it may help provide insights into the potential impacts of Medicaid expansion, said Amy Davidoff, a senior researcher scientist at Yale School of Public Health.

“The post-expansion difference between the two groups’ access to timely care was no longer statistically significant,” Davidoff, who is also a senior research scientist in Yale Cancer Center’s Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, said in a statement. “Our results suggest that Medicaid expansion led to improved health equity.”

Instead, the data is a jumping off point to better understand how the ACA has impacted cancer care and health disparities.

“I see this as contributing to our understanding of how the ACA might be affecting the process of cancer care, and how it might affect disparities in that care,” Davidoff concluded.

Separate research has yielded similar findings. A 2017 research report presented at the American Society for Radiation Oncology’s (ASTRO’s) Annual Meeting also found that Medicaid expansion reduced health disparities because it drove equity in patient care access.

After looking at medical records for over 197,000 adult cancer patients, researcher Fumiko Chino, MD, found that more low-income and otherwise minority patients received healthcare coverage following Medicaid expansion. This in turn closed care gaps among these patients.

Specifically, the uninsured rate decreased from 4.4 percent to 2.1 percent between 2011 and 2014. This stemmed from increases in Medicaid coverage as well as increases in private insurance coverage. The number of Medicaid patients increased from about 15 percent to 18 percent during the study period, while the number of privately insured patients increased modestly from about 75 percent to around 77 percent.

And because these results were more pronounced among low-income or racial minority patients, Chino, who is a Duke University School of Medicine radiation oncology resident, concluded that Medicaid expansion may have been the key to health equity.

"Uninsured cancer patients are more likely to go without needed care and treatment, such as radiation therapy or surgery to remove tumors," Chino said.

"We conducted a study looking at insurance patterns before and after Medicaid expansion and found that un-insurance rates dropped significantly following expansion,” Chino added. “The program appears to have improved access and decreased health care disparities in cancer patients receiving radiation therapy, with the greatest benefits seen among vulnerable individuals living in the highest poverty areas."