Medicaid expansion enabled earlier diagnosis of head, neck cancer

Jan. 16 (UPI) — Insurance can be a life-saver for people with expensive and difficult-to-treat conditions like head and neck cancers.

The latest analysis of Medicaid expansion under the Affordable Care Act, published Thursday in the journal JAMA Otolaryngology-Head & Neck Surgery, suggests that the growing numbers of people who now have coverage under the law have benefited in terms getting diagnosed and, in some cases, starting treatment earlier.

The Affordable Care Act, or ACA, also known as Obamacare, was signed into law in 2010. One of the provisions gave individual states the option of expanding Medicaid eligibility to those with incomes less than 138 percent of the federal poverty level.

“Prior studies have shown that Medicaid expansion under the ACA is associated with reductions in socio-demographic disparities in insurance coverage among patients with newly diagnosed cancer,” the authors wrote.

They also noted that their findings demonstrated that Medicaid expansions were associated with an increase in Medicaid insurance coverage, increases in the percentage of patients with non-metastatic, or stage I or II head and neck squamous cell carcinoma and a reduced time to treatment initiation.

For their research, the authors identified 90,789 adults between age 18 and 64 who had been diagnosed with head and neck squamous cell carcinoma between 2010 and 2016. In all, 54,940, or approximately 61 percent, resided in states that had expanded Medicaid under the ACA.

During the study period, the percentage of uninsured patients in Medicaid expansion states dropped from 7.6 percent to 2.8 percent, with the percentage of Medicaid beneficiaries increasing from 16.9 percent to 20 percent and those with private insurance jumping from 63.3 percent to 65.3 percent, due perhaps to the availability of more affordable coverage under the ACA.

In comparison, the percentage of uninsured in non-expansion states fell from 14.6 percent to 10.9 percent, and the percentage of Medicaid beneficiaries declined from 15.7 percent to 13.8 percent.

The percentage of those diagnosed with “localized” disease — or stage I or II — increased in expansion states, compared with non-expansion states, with a difference of 2.3 percentage points, a suggestion that these new Medicaid beneficiaries were being diagnosed at an earlier stage.

Notably, however, the mean time to treatment initiation did not differ between expansion and non-expansion states. In Medicaid expansion states, mean wait times were roughly 85 days both pre- and post-ACA implementation, versus roughly 84 days in non-expansion states.

The exception was in study participants diagnosed with non-oropharyngeal head and neck squamous cell carcinoma — or cancer that is not located in the middle part of the throat — saw time to treatment initiation drop by approximately six days following Medicaid expansion.


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