Background There are substantial disparities in breast and cervical cancer screening that stem from lack of health insurance. Although the Affordable Care Act (ACA) expands insurance coverage to many Americans, there are differences in availability of Medicaid coverage across states. Purpose To understand the potential impact of Medicaid expansions on disparities in preventive care for low-income women by assessing pre-ACA breast and cervical cancer screening across states currently expanding and not expanding Medicaid to low-income adults. Methods Data from the 2012 Behavioral Risk Factor Surveillance System (analyzed in 2014) were used to consider differences in demographics among women for whom screening is recommended, including income and race/ethnicity, across expansion and non-expansion states. Self-reported screening was compared by state expansion status overall, for the uninsured, and for low-income women. Logistic regressions were estimated to assess differences in self-reported screening across expansion and non-expansion states controlling for demographics. Results Women in states that are not expanding Medicaid had significantly lower odds of receiving recommended mammograms (OR=0.87, 95% CI=0.79, 0.95) or Pap tests (OR=0.87, 95% CI=0.79, 0.95). The difference was larger among the uninsured (OR=0.72, 95% CI=0.56, 0.91 for mammography; OR=0.78, 95% CI=0.65, 0.94 for Pap tests). Conclusions As women in non-expansion states remain uninsured while others gain coverage, existing disparities in cancer screening by race and socioeconomic status are likely to widen. Health risks and associated costs to underserved populations must be taken into account in ongoing debates over expansion.

Medicaid expansions during the period from 2000 to 2010 were associated with improved cervical cancer screening rates, which is critical for early cervical cancer detection and prevention of cancer morbidity and mortality in women. The results suggest that more widespread Medicaid expansions may have positive effects on preventive health care for women.

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Medicaid disenrollment is associated with reduced access to care. This finding is relevant for states considering expansions or contractions of Medicaid under the Affordable Care Act.

The results of the current study indicate that Medicaid disenrollment is associated with a later stage of disease at the time of breast cancer diagnosis, thereby providing evidence of the potential negative health impacts of Medicaid contractions. Cancer 2017;123:3312-9. © 2017 American Cancer Society.