CHICAGO (November 23, 2020): The Affordable Care Act's Medicaid expansion for low-income people appears to lead to earlier diagnosis of colon cancer, enhanced access to care, and improved surgical care for patients with this common cancer, researchers report in a new study. The study is published as an "article in press" on the Journal of the American College of Surgeons website in advance of print.
In states that expanded Medicaid health insurance coverage in 2014, the study authors reported an increase of early-stage colon cancer diagnoses compared with states that did not implement Medicaid expansion. More surgical patients from states with Medicaid expansion had minimally invasive surgical procedures, and fewer patients underwent urgent operations than in states not implementing expansion, said lead author Richard S. Hoehn, MD, surgical oncology fellow with the University of Pittsburgh Medical Center (UPMC) department of surgery at UPMC Hillman Cancer Center, Pittsburgh, Pa.
"A paucity of studies looks at how Medicaid expansion affects cancer treatment and outcomes, as our study did," Dr. Hoehn said. "Our study also differed from others in that we analyzed data only from people who were most likely affected by Medicaid expansion: those aged 40 to 64 who had Medicaid or no health insurance."
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Medicaid expansion, which took effect January 1, 2014, extended this public health insurance coverage to more low-income people.1 Initially, 19 states did not implement Medicaid expansion, but to date, all but 12 states have adopted the expansion.1
Access to health care may be especially important for colon cancer, the authors wrote in their article. Colon and rectal cancer is the fourth most common cancer in the United States and is increasing among adults younger than age 652--those not yet eligible for Medicare, the country's public health insurance for seniors. Despite the availability of colonoscopy to screen for colorectal cancer, the American Cancer Society reports that one in three Americans who should receive this screening do not, for reasons including inadequate health insurance.3
The researchers used data on invasive colon cancer collected in the National Cancer Database (NCDB), the largest cancer registry of its kind. Cosponsored by the American College of Surgeons and the American Cancer Society, the NCDB includes information on more than 70 percent of newly diagnosed cancer cases in the U.S.