American Society of Clinical Oncology Policy Statement on Medicaid Reform

Polite, Blasé N.; Griggs, Jennifer J.; Moy, Beverly; Lathan, Christopher S.; duPont, Nefertiti C.; Villani, Gina; Wong, Sandra L.; Halpern, Michael T.

doi:10.1200/jco.2014.56.3452

Cited by 35 publications

(39 citation statements)

References 40 publications

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“…AYAs with no insurance are more likely to experience delays in treatment initiation [24] and less likely to receive definitive treatment [11], and estimates for treatment non-adherence among AYAs with cancer range from 27% to 60% [27]. In addition, the quality of cancer-care received at safety-net hospitals may not be comparable to other hospitals [28]. Furthermore, we have shown that AYA survivors without insurance more frequently report cancer-related information needs [29], and are less likely to receive cancer-related medical care in survivorship compared to survivors with insurance [5]—factors that may put uninsured AYA survivors at greater risk for long-term cancer-related complications.…”

Section: Discussionmentioning

confidence: 99%

Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status

DeRouen

Parsons

Kent

et al. 2017

Cancer Causes Control

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Purpose To investigate associations of sociodemographic factors—race/ethnicity, neighborhood socioeconomic status (SES), and health insurance—with survival for adolescent and young adults (AYAs) with invasive cancer. Methods Data on 80,855 AYAs with invasive cancer diagnosed in California 2001–2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival. Results Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs. Conclusions Lacking or having public insurance was consistently associated with higher morality, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest social factors also need consideration in intervention and policy development.

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Section: Discussionmentioning

confidence: 99%

Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status

DeRouen

Parsons

Kent

et al. 2017

Cancer Causes Control

View full text Add to dashboard Cite

show abstract

“…This may be of particular significance for cancer patients who may experience a rapid decline in their condition and prognosis as a result of delays in diagnosis and treatment. To improve access of care for Medicaid patients, ASCO and other organizations thus argue for further legislative changes including a permanent and nationwide increase in Medicaid reimbursement rates to the level of Medicare for cancer-related expenditures [6], extending Medicaid coverage for cancer screening and prevention services [39], ensuring equivalent Medicaid coverage for intravenous and oral chemotherapy agents through legislation such as the Cancer Treatment Parity Act of 2015 [40,41], and extending coverage for clinical trial participation to cancer patients with Medicaid [6]. Failing to address these issues will widen socioeconomic disparities as low-income and Medicaid-insured individuals continue to be unable to access adequate cancer care.…”

Section: Potential Impact Of Current and Future Policies On Cancer Dispmentioning

confidence: 99%

“…Formed under the ACA, the marketplace provides a means for businesses, families and individuals to learn about, compare and purchase insurance policies. The federal government subsidizes marketplace policies for those with incomes between 100 and 400% of the FPL [6]. In the 16 states not participating in the Medicaid expansion that have set Medicaid eligibility below 100% FPL, however, a coverage gap exists between Medicaid eligibility and subsidized marketplace policies.…”

Section: Potential Impact Of Current and Future Policies On Cancer Dispmentioning

confidence: 99%

“…Moreover, cancer patients who are uninsured as a result of the coverage gap have incomes below the FPL and are thus unlikely to substantially contribute to their diagnostic and treatment expenses. As such, the ASCO advocates to further reduce rates of those without insurance by eliminating the coverage gap through unanimous state participation in the Medicaid expansion [6].…”

Section: Potential Impact Of Current and Future Policies On Cancer Dispmentioning

confidence: 99%

“…The extent to which the ACA will eliminate cancer disparities, however, is uncertain. The American Society of Clinical Oncology (ASCO) and other cancer advocacy groups have called for further healthcare reform to ensure equal and adequate access to high quality cancer care for all patients, regardless of insurance or socioeconomic status [6].…”

mentioning

confidence: 99%

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A Brighter Future? The Impact of Insurance and Socioeconomic Status on Cancer Outcomes in the USA: A Review

et al. 2016

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Uninsured and Medicaid-insured cancer patients have been shown to present with more advanced disease, less often receive cancer-directed therapy and suffer higher rates of mortality than those with private insurance. The Patient Protection and Affordable Care Act was signed into law in March of 2010 and seeks to increase rates of public and private health insurance. Although several provisions will in particular benefit those with chronic and high-cost medical conditions such as cancer, the extent to which disparities in cancer care will be eliminated is uncertain. Further legislative changes may be needed to ensure equal and adequate cancer care for all patients regardless of insurance or socioeconomic status.

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Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

et al. 2020

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IMPORTANCE Small cell lung cancer (SCLC) is an aggressive neoplasm requiring rapid access to subspecialized multidisciplinary care. For this reason, insurance coverage such as Medicaid may be associated with oncologic outcomes in this disproportionately economically vulnerable population. With Medicaid expansion under the Affordable Care Act, it is important to understand outcomes associated with Medicaid coverage among patients with SCLC. OBJECTIVE To determine the association of Medicaid coverage with survival compared with other insurance statuses. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients with limitedstage (LS) and extensive-stage (ES) SCLC in the US National Cancer Database from 2004 to 2013. Data were analyzed in January 2019. MAIN OUTCOMES AND MEASURES Patients were analyzed with respect to insurance status. Associations of insurance status with survival were interrogated with univariate analyses, multivariable analyses, and propensity score matching. RESULTS A total of 181 784 patients with SCLC (93 131 [51.2%] female; median [interquartile range] age; 67 [60-75] years for patients with LS-SCLC and 68 [60-75] years for patients with ES-SCLC) were identified, of whom 70 247 (38.6%) had LS-SCLC and 109 479 (60.2%) had ES-SCLC. On univariate analyses of patients with LS-SCLC, Medicaid coverage was not associated with a survival advantage compared with being uninsured (hazard ratio, 1.02; 95% CI, 0.96-1.08; P = .49). Likewise, on multivariable analyses of patients with ES-SCLC, compared with being uninsured, Medicaid coverage was not associated with a survival advantage (hazard ratio, 1.00; 95% CI, 0.96-1.03; P = .78). After propensity score matching, median survival was similar between the uninsured and Medicaid groups both among patients with LS-SCLC (14.4 vs 14.1 months; hazard ratio, 1.05; 95% CI, 0.98-1.12; P = .17) and those with ES-SCLC (6.3 vs 6.4 months; hazard ratio, 1.00; 95% CI, 0.96-1.04; P = .92). CONCLUSIONS AND RELEVANCE Despite of billions of dollars in annual federal and state spending, Medicaid was not associated with improved survival in patients with SCLC compared with being uninsured in the US National Cancer Database. These findings suggest that there are substantial outcome inequalities for SCLC relevant to the policy debate on the Medicaid expansion under the Affordable Care Act.

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American Society of Clinical Oncology Policy Statement on Medicaid Reform

Cited by 35 publications

References 40 publications

Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status

Sociodemographic disparities in survival for adolescents and young adults with cancer differ by health insurance status

A Brighter Future? The Impact of Insurance and Socioeconomic Status on Cancer Outcomes in the USA: A Review

Association of Medicaid Insurance With Survival Among Patients With Small Cell Lung Cancer

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