By Richard Rosen, MD
It is cruel that a coverage gap exists for North Carolinians who make too much to qualify for Medicaid but not enough to purchase insurance under the Affordable Care Act. More than 500,000 would gain coverage if NC joined the 38 other states that have expanded Medicaid and it would improve chances of surviving cancer for those patients diagnosed with certain types of cancer.
A study in the peer reviewed journal, JAMA Network Open, released November 5, 2020, concluded that states that expanded Medicaid had significant lower mortality than non-expansion states in breast, colon and lung cancer. Prior research demonstrated an increase in early stage cancer diagnosis in expansion vs. non-expansion states. Expanding Medicaid improves access to screening and timely symptom evaluation, which the authors suggest may account for the mortality difference.
The study gleaned statistics from the National Cancer Database and included 523,802 cancer patients. The estimated effect was prevention of 1 death for every 250 patients with cancer gaining coverage for 4 years after cancer diagnosis. The benefit was seen in patients with localized (Stages I – III) but not metastatic (Stage IV) cancers. With recent emphasis on racial disparities, it is noteworthy that the mortality differences associated with Medicaid Expansion did not differ for Black and white patients.
We’ve known that expansion states have increased access to care and improved control of chronic conditions such as diabetes and hypertension, but the finality of mortality difference that this study provides deserves our attention.