ACA Medicaid Expansion Shows Cancer Mortality Benefit, Especially Among Hispanics

Medicaid expansion under the Affordable Care Act resulted in a decrease in cancer mortality rates that translated into 785 fewer cancer deaths in 2017 expansion states, according to results of a study scheduled to be presented at annual meeting of American Society of Clinical Oncology (ASCO), which is now scheduled to be held virtually May 29-31 instead of in Chicago.

The difference in cancer mortality rate between expansion and nonexpansion states was especially pronounced among Hispanics, reported the research team led by Anna Lee, M.D., M.P.H., of the Memorial Sloan Kettering Cancer Center in New York City. Lee said the result for Hispanics might be explained by high uninsurance rates and the large coverage increases from Medicaid expansion.

The overall cancer mortality benefit in the expansion states compared with nonexpansion states was 0.5 fewer deaths per 100,000 people after statistical adjustments for age, according to Lee and her colleagues. Among Hispanics, the cancer mortality benefit in the expansion states was 2.1 fewer deaths per 100,000. Those results did not reach the conventional standard for statistical significance, but senior author Fumiko Chino said that was most conservative way to compute the effect of Medicaid expansion. (When the before-and-after comparisons were confined to the expansion states, the results did reach statistical significance for the overall comparison and for whites and Hispanics.  

The 2012 Supreme Court decision that made Medicaid expansion under the ACA a state-by-state decision has created a natural experiment in what the effects of Medicaid coverage have on health outcomes, and a number of studies have looked more specifically at the effects on cancer and cancer care. In a slide presentation of her findings, Lee said noted that cancer is seen “health care amenable” condition with access to health care likely to have an influence on outcomes. Lee and her colleagues say theirs is the first study to directly measure the cancer mortality benefit of ACA Medicaid expansion. 

The researchers compared the 27 states and Washington, D.C., that had expanded Medicaid as of Jan. 1, 2015, to the 23 states who hadn’t. The time period comparison was between 2011-2013, the “before” in the before-and-after comparison, and 2015-2017, the “after.”

In the expansion states, the cancer mortality rate fell by 1.1 death per 100,000 between those two time periods. In the nonexpansion states it fell by just  0.6 per 100,000. Based on that difference and other calculations, the researchers estimated that if all states expanded Medicaid, 589 cancer deaths would have been prevented.

When they looked at subgroups, they found that Medicaid expansion did not have cancer mortality benefit among black Americans. Lee said one explanation was that cancer mortality rates among blacks were already falling at faster rate.

The backdrop for this study is an overall decline in the age-adjusted cancer mortality rate over the past couple of decades. Lee and her colleagues noted that the overall age-adjusted in the U.S. fell from 66.9 per 100,000 in 1999 to 48.8 in 2017.

The abstract for this study was one of five presented as part of pre-meeting “presscast” for the annual ASCO meeting.