Study shows protective effect of Medicaid expansion on early-stage cancer diagnosis

The COVID-19 pandemic disrupted health care, including cancer screening and diagnosis, especially for medically underserved populations, leading to substantial underdiagnosis of early-stage cancers in 2020. In a new study led by the American Cancer Society (ACS), scientists found that Medicaid expansion was associated with smaller declines in early-stage cancer detection among adults during the pandemic. The study is to be published today in the Journal of the National Cancer Institute (JNCI).

Many people experienced job disruptions and financial instability during the pandemic, which led to cost barriers to timely care. This data suggests a protective effect of Medicaid expansion on cancer early diagnosis during the public health emergency."

Dr. Xuesong Han, scientific director, health services research at the American Cancer Society and lead author of the study

For the study, researchers compared changes in proportions of early-stage (stage I/II) cancer diagnosis in Medicaid expansion states versus non-expansion states. Scientists analyzed data among 1,844,515 individuals aged 18-64 years newly diagnosed with cancer in 2018-2022 from the National Cancer Database using a difference-in-differences (DD) approach. Adjusted DD estimates were calculated and stratified by key sociodemographic factors and cancer type.

The results showed that the uninsured percentage among patients aged 18-64 years newly diagnosed with cancer remained stable at around 2% in Medicaid expansion states and an estimated 8% in non-expansion states. The proportion of early-stage diagnoses declined following the COVID-19 pandemic, but the decline was considerably smaller in Medicaid expansion states than in non-expansion states, particularly pronounced among patients aged 18-44 years, patients who are male with high comorbidity burden, and treated in academic facilities; the populations who were most likely to obtain insurance coverage through Medicaid expansion.

"Our findings can inform policymakers and the public in the 10 states that have yet to expand Medicaid eligibility," Han added. "The findings also provide critical information for policymakers and the public in all states about the public health implications of upcoming large federal cuts to Medicaid programs and expected loss of insurance coverage for more than 10 million adults."

"This research adds to the mountain of existing proof that Medicaid expansion saves lives from cancer by reducing the number of people who are uninsured," said Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of ACS. "ACS CAN has long advocated for Medicaid expansion, and our work continues as states begin to contemplate how to implement the drastic changes from this summer's budget reconciliation law. These recent changes made by Congress to cut Medicaid will undo decades of progress in the fight against cancer. Increasing and protecting existing access to this critical program must be a priority nationwide if we are to end cancer as we know it, for everyone." Other ACS researchers contributing to the study include Nova Yang, MSPH, Dr. Qinjin Fan, Dr. Leticia Nogueira, Dr. Ahmedin Jemal, and senior author Dr. Robin Yabroff.