Understanding the Implications of Medicaid Expansion for Cancer Care in the US

Abstract

Insurance status has been linked to important differences in cancer treatment and outcomes in the US. With more than 15 million individuals gaining health insurance through Medicaid expansion, there is an increasing need to understand the implications of this policy within the US cancer population. This review provides an overview of the fundamental principles and nuances of Medicaid expansion, as well as the implications for cancer care.OBSERVATIONS The Patient Protection and Affordable Care Act presented states with an option to expand Medicaid coverage by broadening the eligibility criteria (eg, raising the eligible income level). During the past 10 years, Medicaid expansion has been credited with a 30% reduction in the population of uninsured individuals in the US. Such a significant change in the insurance profile could have important implications for the 1.7 million patients diagnosed with cancer each year, the oncology teams that care for them, and policy makers. However, several factors may complicate efforts to characterize the effect of Medicaid expansion on the US cancer population. Most notably, there is considerable variation among states in terms of whether Medicaid expansion took place, when expansion occurred, eligibility criteria for Medicaid, and coverage types that Medicaid provides. In addition, economic and health policy factors may be intertwined with factors associated with Medicaid expansion. Finally, variability in the manner in which cancer care has been captured and depicted in large databases could affect the interpretation of findings associated with expansion. CONCLUSIONS AND RELEVANCEThe expansion of Medicaid was a historic public policy initiative. To fully leverage this policy to improve oncological care and to maximize learning for subsequent policies, it is critical to understand the effect of Medicaid expansion. This review aims to better prepare investigators and their audiences to fully understand the implications of this important health policy initiative.

Immunotherapy After Chemotherapy and Radiation for Clinical Stage III Lung Cancer

“…26 Our results also confirmed an advantage of immunotherapy among a cohort that included a range of payers (12% had Medicaid or were uninsured), which is important as payer status has been associated with both the delivery of care and potentially the outcomes of cancer treatment. 27,28 The majority of patients in this study (65%) were treated differently than in the PACIFIC trial, which is in line with findings in the PACIFIC-R multinational observational trial where the median time to treatment was 52 days (survival not characterized). 29 Our results suggest there may be flexibility in the time to initiate immunotherapy after the completion of radiation.…”

Financial toxicity in hematological malignancies: a systematic review

“…Another change pertinent to our review is the advent of new technologies or policies to potentially alleviate FT, for example, Medicaid expansion through the Affordable Care Act or online crowdfunding platforms such as GoFundMe [ 66 – 68 ]. Regardless of these steps, however, our review demonstrates the durability of FT as a patient-facing barrier in need of better recognition and management.…”

Association of Insurance Status and Extent of Organ Involvement With Survival Among Patients With Stage IV Cancer

“…These disparities may relate to receiving a diagnosis later in the course of stage IV disease, potentially reflecting decreased access to general practitioners, cancer screening, and treatment. 1 , 2 , 3 Although modest in magnitude, the finding that underinsured patients were more likely to present with multiorgan involvement, which carries a worse prognosis, was observed across multiple cancer types and is consistent with delayed presentation. Further exploration into the social determinants of health is needed, 4 as the poorer prognosis of socioeconomically disadvantaged patients persisted even after controlling for metastatic burden.…”