Early Expansion of Medicaid Associated with Decreased Cancer Mortality

An association has been identified between early expansion of Medicaid and reduced cancer mortality, particularly for patients with pancreatic cancer, according to findings from a study published in the Journal of the National Cancer Institute.¹

Early expansion yielded a statistically significant decrease of 3.07 cancer deaths (95% CI, 2.19-3.95) per 100,000 compared with non-expansion states. Moreover, expansion states had 64.8 cancer deaths per 100,000 compared with 79.4 deaths per 100,000 in states that did not receive the Medicaid expansion. Investigators reported this translates to an estimated decline by 5276 cancer deaths among states that utilized early expansion throughout the study period.

“We wanted to look at changes over time because we expected advancements in cancer care were made whether the state expanded Medicaid or not. By comparing mortality rates in this way, we were able to measure whether expanding Medicaid affected cancer mortality, and we found that it did,” study author Evan Graboyes, MD, head and neck surgical oncologist and Cancer Control Program researcher at Medical University of South Carolina Hollings Cancer Center, said in a press release.²

Despite previously established associations between Medicaid with decreased uninsured rates and earlier cancer diagnoses, this marks the first study to examine the association between Medicaid expansion and cancer mortality, according to the study’s investigators.

Country-level data was pulled from the National Center for Health Statistics, and included adult patients with cancer between the ages of 20 and 64 who died prior to the expansion from 2007 to 2009 or following the expansion from 2012 to 2016. Investigators assessed how cancer mortality rates changed in states that received early Medicaid expansion, including California, Connecticut, Minnesota, New Jersey, and Washington, compared with non-expansion states. Notably, South Carolina remains as 1 of the 11 states that did not receive a Medicaid expansion. Additionally, an exploratory analysis assessed changes in cancer mortality that were possibly associated with larger scale Medicaid expansions that took place in 2014.

Specifically, an exploratory analysis of the 2014 Medicaid expansion highlighted a decrease in pancreatic cancer mortality of -0.18 deaths per 100,000 (95% CI, -0.32 to -0.05) among states that expanded Medicaid. Investigators reported that from 2007 to 2016, cancer deaths decreased from 4.47 to 4.22 deaths per 100,00 in states that received the expansion compared with 4.72 to 4.87 deaths per 100,000 among states that did not get the Medicaid expansion. Lower mortality was also observed for other malignancies such as breast, cervical, and prostate cancer in expansion states.

“This is important because cancer types like pancreatic have a poor prognosis overall. These are areas researchers are especially interested in studying to improve overall patient outcomes,” Graboyes stated.

The investigators emphasized that additional research will be necessary in order to improve patient outcomes and that Medicaid expansion alone is not a cure-all for current challenges in cancer care.

“It is important to stress that Medicaid expansion is not the silver bullet or the panacea to the problem of health disparities and social determinants of health that has plagued cancer survivorship for so long. We hope that when people examine Medicaid expansion or the Affordable Care Act that they see that its implications could be more than just preference or choice. It could be a matter of life and death for some cancer survivors,” senior author Nosayaba Osazuwa-Peters, PhD, an assistant professor at the Duke University School of Medicine and a member of the Duke Cancer Institute, concluded.

References

1. Barnes JM, Johnson KJ, Boakye EA, et al. Early Medicaid expansion and cancer mortality. J Nat Can Inst. Published online July 14, 2021. doi:10.1093/jnci/djab135
2. Study finds link between Medicaid expansion and lower cancer mortality. News release. Medical University of South Carolina. November 22, 2021. Accessed November 23, 2021. https://bit.ly/3xf0pnD