BACKGROUND: Under the Affordable Care Act, Medicaid expansion effective 1 January 2014 aimed to increase access to health care. We sought to determine the association of Medicaid expansion with disparities in utilization of breast reconstruction. METHODS: Non-Hispanic Black (NHB) and White (NHW) breast cancer patients undergoing mastectomy +/- reconstruction between 2010 and 2017 were selected from the National Cancer Database. Annual trends for utilization of breast reconstruction by race, income, and education were evaluated by Medicaid expansion status using difference-in-differences regression analyses. Medicaid expansion was categorized by expansion date as early (2010-2013), 2014 (1/2014), late (after 1/2014), or no expansion. RESULTS: Of 443,607 patients, 36.3% (n = 161,128) underwent reconstruction, 13.1% (n = 58,249) were NHB, 16.8% (n = 74,430) had median income < $40,227, and 17.1% (n = 75,718) were in the lowest education quartile. In non-expansion states, lower proportions of NHB patients underwent reconstruction than NHW patients in all years, with the smallest disparity (NHB% - NHW%) (- 6.4%) in 2017. Decreases in disparities between NHB and NHW patients were seen with the smallest difference observed in 2014 (- 2.5%) in early-expansion states, in 2017 (- 0.7%) in 1/2014 expansion states, and in 2017 (- 4.5%) in late-expansion states. Similar findings for convergence of reconstruction utilization rates for the lowest two education levels and lowest two income quartiles were found with Medicaid expansion, with no convergence seen in non-expansion states over the study period. CONCLUSIONS: Some improvement in breast reconstruction disparities followed Medicaid expansion. Failure to improve parity without Medicaid expansion should be a consideration with any modifications to Medicaid access.
BACKGROUND: Under the Affordable Care Act, Medicaid expansion effective 1 January 2014 aimed to increase access to health care. We sought to determine the association of Medicaid expansion with disparities in utilization of breast reconstruction. METHODS: Non-Hispanic Black (NHB) and White (NHW) breast cancerpatients undergoing mastectomy +/- reconstruction between 2010 and 2017 were selected from the National Cancer Database. Annual trends for utilization of breast reconstruction by race, income, and education were evaluated by Medicaid expansion status using difference-in-differences regression analyses. Medicaid expansion was categorized by expansion date as early (2010-2013), 2014 (1/2014), late (after 1/2014), or no expansion. RESULTS: Of 443,607 patients, 36.3% (n = 161,128) underwent reconstruction, 13.1% (n = 58,249) were NHB, 16.8% (n = 74,430) had median income < $40,227, and 17.1% (n = 75,718) were in the lowest education quartile. In non-expansion states, lower proportions of NHB patients underwent reconstruction than NHW patients in all years, with the smallest disparity (NHB% - NHW%) (- 6.4%) in 2017. Decreases in disparities between NHB and NHW patients were seen with the smallest difference observed in 2014 (- 2.5%) in early-expansion states, in 2017 (- 0.7%) in 1/2014 expansion states, and in 2017 (- 4.5%) in late-expansion states. Similar findings for convergence of reconstruction utilization rates for the lowest two education levels and lowest two income quartiles were found with Medicaid expansion, with no convergence seen in non-expansion states over the study period. CONCLUSIONS: Some improvement in breast reconstruction disparities followed Medicaid expansion. Failure to improve parity without Medicaid expansion should be a consideration with any modifications to Medicaid access.
Authors: Elizabeth B Habermann; Andrea Abbott; Helen M Parsons; Beth A Virnig; Waddah B Al-Refaie; Todd M Tuttle Journal: J Clin Oncol Date: 2010-06-14 Impact factor: 44.544
Authors: Claudia R Albornoz; Peter B Bach; Babak J Mehrara; Joseph J Disa; Andrea L Pusic; Colleen M McCarthy; Peter G Cordeiro; Evan Matros Journal: Plast Reconstr Surg Date: 2013-01 Impact factor: 4.730
Authors: Parisa Kamali; Sara L Zettervall; Winona Wu; Ahmed M S Ibrahim; Caroline Medin; Hinne A Rakhorst; Marc L Schermerhorn; Bernard T Lee; Samuel J Lin Journal: Plast Reconstr Surg Date: 2017-04 Impact factor: 4.730
Authors: Patricia A Ganz; Katherine A Desmond; Beth Leedham; Julia H Rowland; Beth E Meyerowitz; Thomas R Belin Journal: J Natl Cancer Inst Date: 2002-01-02 Impact factor: 13.506
Authors: Michael Bezuhly; Claire Temple; Leif J Sigurdson; Roger B Davis; Gordon Flowerdew; E Francis Cook Journal: Cancer Date: 2009-10-15 Impact factor: 6.860
Authors: Mark Sisco; Hongyan Du; Jeremy P Warner; Michael A Howard; David P Winchester; Katharine Yao Journal: J Am Coll Surg Date: 2012-08-24 Impact factor: 6.113
Authors: J Ferlay; M Colombet; I Soerjomataram; C Mathers; D M Parkin; M Piñeros; A Znaor; F Bray Journal: Int J Cancer Date: 2018-12-06 Impact factor: 7.396