Health Services Research
PV QA 3 - Poster Viewing Q&A 3
TU_39_2980 - Early Impact of the Affordable Care Act and Medicaid Expansion on Racial and Socioeconomic Disparities in Cancer Care
Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3
Early Impact of the Affordable Care Act and Medicaid Expansion on Racial and Socioeconomic Disparities in Cancer Care
B. A. Mahal1, J. Chavez2, A. N. Mahal3, D. D. Yang4, D. W. Kim4, N. N. Sanford5, R. Sethi3, J. C. Hu6, Q. D. Trinh7, and P. L. Nguyen8; 1Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, 2Brigham and Women's Hospital, Boston, MA, 3Massachusetts General Hospital, Boston, MA, 4Harvard Medical School, Boston, MA, 5Harvard Radiation Oncology Program, Boston, MA, 6NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, 7Center for Surgery and Public Health and Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 8Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
Purpose/Objective(s): To evaluate trends of historic sociodemographic disparities in insurance coverage and cancer treatment patterns in non-elderly adults with a common cancer after Affordable Care Act (ACA) implementation, based on state approach to Medicaid expansion.
Materials/Methods: A national cohort of 109,182 patients ages 18-64 diagnosed with a common cancer (lung, breast, or prostate cancer) was identified from 2010-2014. Multivariable logistic regressions analyzed associations between ACA implementation and cancer outcomes based on state approach to Medicaid expansion, stratified by race (black, white) and income (stratified at 138% federal poverty line [FPL]). Interaction terms were applied as appropriate.
Results: Both uninsured rates and cancer treatment rates declined after ACA implementation, with the greatest rate reductions associated with Medicaid expansion (Pinteraction<0.001 and Pinteraction=0.024, respectively). Racial disparities in insurance coverage were eliminated with Medicaid expansion where the uninsured rate went from 10.0% to 0.95% among black patients (AORpre-aca1.52 to AORpost-aca0.47), but persisted with other state approaches (AORpre-aca 1.15 to AORpost-aca1.12) [Pinteraction=0.002]. However, racial disparities in cancer treatment did not change by state approach to Medicaid (Pinteraction=0.516). Furthermore, socioeconomic coverage gaps were eliminated with Medicaid expansion, where the uninsured rate went from 8.4% to 1.4% among low-income (≤138% FPL) patients, but not with other state approaches [Pinteraction<0.001]. Nevertheless, Medicaid expansion was associated with greater cancer treatment gaps between low and higher income patients (AORpre-aca0.85 to AORaca0.72) versus other state options (AORpre-aca1.07 to AORaca1.48) [Pinteraction<0.001].
Conclusion: Medicaid expansion was associated with the elimination of racial and socioeconomic insurance coverage gaps, but also with persistent and potentially widened treatment gaps. These results highlight the potential benefits and challenges of the ACA and its provisions, and could instruct ongoing policy.
Author Disclosure: B.A. Mahal: None. J. Chavez: None. D.W. Kim: None. N.N. Sanford: None. J.C. Hu: None. P.L. Nguyen: Honoraria; Bayer. Consultant; Nanobiotix, Infinity Pharmaceuticals, GI Windows, Astellas, Augmenix. Advisory Board; Ferring, Medivation, Genome DX, Dendreon. Stock Options; Augmenix. Program Committee; Genitourinary Cancers Symposium.