Healthcare Disparities in Cancer Patients Receiving Radiation: Changes in Insurance Status after Medicaid Expansion under the Affordable Care Act

Publication date: Available online 13 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Fumiko Chino, Gita Suneja, Haley Moss, S. Yousuf Zafar, Laura Havrilesky, Junzo Chino
ObjectiveThe Patient Protection and Affordable Care Act (ACA) was designed to improve healthcare access and decrease disparities. This study compares insurance status in cancer patients receiving radiation before and after Medicaid expansion under the ACA in both expanded and non-expanded states.MethodsNewly diagnosed cancer patients ages 18-64 who received radiation from 2011-2014 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.Results197,290 patients were analysed. 73% lived in expanded states. After expansion, there was a 53% relative decrease in uninsured rates in expanded states (4.3 to 2.1%) and a 5% relative decrease in non-expanded states (8.4 to 8.0%), p<0.0001.In expanded states, 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 <0.0001) 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 <0.0001).In non-expanded states, decrease in uninsured levels was seen primarily in whites (relative decrease 9%, 7.8 to 7.1%, p<0.0001; 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=0.04; high poverty: relative increase 2%, 10.9 to 11.1%, p=0.17).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=0.0093 and p=0.0029 respectively).ConclusionsMedicaid expansion in 2014 significantly decreased uninsured rates for cancer patients receiving radiation. Full expansion decreased rates of uninsurance to a greater degree and appeared to decrease racial and economic disparities.

Teaser

We utilized the SEER database to evaluate changes in uninsurance rates among cancer patients undergoing radiation after Medicaid expansion under the Affordable Care Act. Patients in fully expanded and non-fully expanded states treated with radiation during 2011-2013 were compared to those treated in 2014. Uninsurance rates dropped in all states; however the magnitude was larger in fully expanded states. Non-fully expanded states showed significant racial and county-level poverty disparities in uninsurance levels.


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