Fumiko Chino1, Gita Suneja2, Haley Moss3, S Yousuf Zafar4, Laura Havrilesky3, Junzo Chino2. 1. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina. Electronic address: fumiko.chino@duke.edu. 2. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina. 3. Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina. 4. Duke Cancer Institute, Durham, North Carolina.
Abstract
PURPOSE: To compare insurance status in cancer patients receiving radiation before and after Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), in both expanded and non-expanded states. METHODS AND MATERIALS: Newly diagnosed cancer patients aged 18 to 64 years who received radiation from 2011 to 2014 were compiled from the Surveillance, Epidemiology, and End Results database. Patients with a prior cancer diagnosis or unknown insurance status were excluded. Insurance rates at diagnosis were examined before (2011-2013) and after Medicaid expansion (2014) and compared between states that fully or did not fully expand Medicaid. RESULTS: A total of 197,290 patients were analyzed. Of these, 73% lived in expanded states. After expansion, there was a 53% relative decrease in uninsured rates in expanded states (4.3%-2.1%) and a 5% relative decrease in non-expanded states (8.4%-8.0%) (P < .0001). In expanded states, the uninsured rate decreased regardless of race (whites: relative decrease 56%, 4.3% to 1.9%; blacks: relative decrease 50%, 6.0 to 3.0%; both P < .0001) or county poverty level (low poverty: relative decrease 46%, 3.9% to 2.1%; high poverty: relative decrease 60%, 4.5% to 1.8%; both P < .0001). In non-expanded states, a decrease in uninsured levels was seen primarily in whites (relative decrease 9%, 7.8% to 7.1%, P < .0001; blacks: relative increase 7%, 9.9% to 10.6%, P = .37) and those living in areas with the lowest poverty (relative decrease 27%, 4.8% to 3.5%, P = .04; high poverty: relative increase 2%, 10.9% to 11.1%, P = .17). Blacks and those living in the highest poverty areas had the greatest level of benefit from full expansion (absolute benefit 2.0%-2.3%, P = .0093 and P = .0029, respectively). CONCLUSIONS: Medicaid expansion in 2014 significantly decreased uninsured rates for cancer patients receiving radiation. Full expansion decreased rates of uninsurance to a greater degree and seemed to decrease racial and economic disparities.
PURPOSE: To compare insurance status in cancerpatients receiving radiation before and after Medicaid expansion under the Patient Protection and Affordable Care Act (ACA), in both expanded and non-expanded states. METHODS AND MATERIALS: Newly diagnosed cancerpatients aged 18 to 64 years who received radiation from 2011 to 2014 were compiled from the Surveillance, Epidemiology, and End Results database. Patients with a prior cancer diagnosis or unknown insurance status were excluded. Insurance rates at diagnosis were examined before (2011-2013) and after Medicaid expansion (2014) and compared between states that fully or did not fully expand Medicaid. RESULTS: A total of 197,290 patients were analyzed. Of these, 73% lived in expanded states. After expansion, there was a 53% relative decrease in uninsured rates in expanded states (4.3%-2.1%) and a 5% relative decrease in non-expanded states (8.4%-8.0%) (P < .0001). In expanded states, the uninsured rate decreased regardless of race (whites: relative decrease 56%, 4.3% to 1.9%; blacks: relative decrease 50%, 6.0 to 3.0%; both P < .0001) or county poverty level (low poverty: relative decrease 46%, 3.9% to 2.1%; high poverty: relative decrease 60%, 4.5% to 1.8%; both P < .0001). In non-expanded states, a decrease in uninsured levels was seen primarily in whites (relative decrease 9%, 7.8% to 7.1%, P < .0001; blacks: relative increase 7%, 9.9% to 10.6%, P = .37) and those living in areas with the lowest poverty (relative decrease 27%, 4.8% to 3.5%, P = .04; high poverty: relative increase 2%, 10.9% to 11.1%, P = .17). Blacks and those living in the highest poverty areas had the greatest level of benefit from full expansion (absolute benefit 2.0%-2.3%, P = .0093 and P = .0029, respectively). CONCLUSIONS: Medicaid expansion in 2014 significantly decreased uninsured rates for cancerpatients receiving radiation. Full expansion decreased rates of uninsurance to a greater degree and seemed to decrease racial and economic disparities.
Authors: Kelsey L Corrigan; Leticia Nogueira; K Robin Yabroff; Chun Chieh Lin; Xuesong Han; Junzo P Chino; Anna E Coghill; Meredith Shiels; Ahmedin Jemal; Gita Suneja Journal: Cancer Date: 2019-11-11 Impact factor: 6.860