Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut

July 05, 2017 - A significant rollback of Medicaid coverage in Tennessee has led to a spike in late stage diagnosis for breast cancer, according to a new data analysis published in the American Cancer Society journal Cancer.

The research team led by Virginia Commonwealth University’s Wafa Tarazi, PhD, of, and University of Pittsburgh’s Lindsay Sabik, PhD, compared women living in a low-income area with their counterparts living in a high-income one. The results showed a greater shift toward late stage diagnosis for former.

While both legislators and healthcare providers continue to debate the impact of Medicaid expansions and contractions on population health, the study’s results serve to support earlier findings that increased access to healthcare improves overall health for low-income populations.

With over 70 million people receiving healthcare coverage, Medicaid is currently the nation’s largest health insurer, including 12 million enrollees who became eligible under the Affordable Care Act (ACA) Medicaid expansion. Although federal funds were offered to completely cover the cost of Medicaid expansion, only 31 states have since opted to take the opportunity. Tennessee was not one of those states which accepted the Medicaid expansion.

In this recent study, researchers utilized data from before and after Tennessee implemented restrictions on Medicaid enrollment in 2005. These restrictions included cutting over 190,000 individuals off from TennCare, the state’s Medicaid program.

"We show that when a large population in a state loses Medicaid coverage, low-income women are more likely to be diagnosed with breast cancer at later stages, suggesting that they did not receive screening or other primary care that may have facilitated earlier diagnosis," said Tarazi. "Our findings are important for policy makers who are considering changes to the Medicaid program."

Overall, nonelderly women in Tennessee were diagnosed at later stages and experienced more delays in treatment in the period after restrictions. There was also a 3.3 percentage point increase in late-stage diagnosis for women living in low-income zip codes relative to women living in high-income zip codes.

The report noted, that despite legislators attempts across the nation to address their state’s financial shortcomings with Medicaid cuts, the long-term effects could be higher acute care costs and a disproportionate impact on the health of low-income populations. "Medicaid rollbacks may contribute to widening disparities in health outcomes between low-income women and their wealthier counterparts," added Sabik.

In an accompanying editorial Sujha Subramanian, PhD, of RTI International, and Nancy Keating, MD, MPH, of Brigham and Women's Hospital commented, “It is important that these policy makers understand that such short-term policies have longer-term consequences for the health of the low-income population, for whom Medicaid is often the only health insurance coverage option."

The results of the study reinforce previous research on Medicaid’s effects on the rates of recommended breast cancer screenings for low-income women. In states that had accepted the Medicaid expansion, the rates of testing were higher than in states without.

“While increased use of screening mammography has significantly contributed to improved detection of breast cancer, substantial disparities in breast cancer screening exist among populations in the country,” said fellow researcher, Soudabeh Fazeli Dehkordy, MD, MPH, from St. John’s Providence Hospital in when presenting results from an earlier study on of the effect of Medicaid enrollment on breast cancer screenings at annual meeting of the Radiological Society of North American in 2015. “We sought to determine whether increasing access to health insurance through Medicaid expansion has resulted in improved breast cancer screening adherence.”

In the previous study, researchers were able to determine that prior to Medicaid expansion low-income women in both expansion and non-expansion states had the same level of breast cancer screenings.

After the ACA Medicaid expansion, the women in expansion states witnessed a 25 percent increase in obtaining mammogram screenings. “Understanding the impact of Medicaid expansion on breast cancer screening rates in early expander states can provide valuable insights that can be very useful to both state and federal policymakers when considering key health policy," claimed Dehkordy.

“Adoption of Medicaid expansion by more states can result in considerable improvement of disparities in breast cancer screening, leading to better health outcomes for all women across the United States,” Dehkordy concluded.