Cancer Screening for Uninsured Low-Income Women in States Not Expanding Medicaid

The fact that uninsured low-income women face financial barriers to receiving recommended screenings for breast and cervical cancer is already known. However, a new study finds that in states that have not expanded Medicaid, these women face even more difficulties in accessing such services.

The study, published in Women’s Health Issues, stresses that there is an increasing need for more programs that support cancer screening for low-income uninsured women.

Over the past 10 years, the screening rates for cervical and breast cancer in US have decreased if not remained stagnant. The Affordable Care Act (ACA) has decreased the number of uninsured Americans and has substantially expanded access to cancer screening and reduced financial barriers; however, there are still millions of low-income women that remain uninsured and face financial hurdles to screening.

According to the Congressional Budget Office’s estimates, the ACA will reduce the number of uninsured Americans by 24 million by 2017. That means as many as 27 million people will remain uninsured without an affordable healthcare coverage option. This could be because of a variety of reasons: states that do not expand Medicaid, ineligibility of some people to participate in Medicaid, or undocumented immigrants who cannot apply for assistance.

Specifically, if the current non-expansion states do not change course by 2017, an estimated 23% of low-income women between the ages of 21 and 64 in these states will remain uninsured. The lead author of the study, Leighton Ku, PhD, MPH, noted that this is a disproportionate number as compared to 8% on women that will remain uninsured in Medicaid expansion states.

The Study and Its Implications

The study used data of women aged 18 to 64 from the 2013 American Community Survey Public Use Microdata Sample. The study also includes demographic and psychographic information of the women. The study assessed 2 scenarios:

• Only 29 states expand Medicaid in 2017
• All states expand Medicaid by 2017

The results present a clear picture. Under the first scenario, if only some states expand Medicaid, then 18% of low-income women remain uninsured. But if all states adopt the expansion, then the uninsured rate for these women drops to 10%.

Need for More Attention to Low-Income Uninsured Women

The study clearly highlights the impact health insurance expansions under the ACA will have on low-income women: they will experience an undisturbed financial access to breast and cervical cancer screening. This, in turn, can lead to early detection and improved outcomes.

If non-expanding states opt to expand Medicaid and encourage health insurance exchanges, then the positive results will be 2-fold:

• The number of uninsured women can be reduced
• The number of low-income uninsured women opting for cancer screening can be boosted

“Health reform, including Medicaid expansion, is increasing insurance coverage and financial access to breast and cervical cancer screening for low-income women” Dr Ku said. “But services for low-income uninsured women are still needed.”