Kentucky's Medicaid Expansion Associated With Improved Breast Cancer Care

Medicaid expansion in Kentucky led to earlier diagnosis and improved quality of care for women aged 20 to 64 with breast cancer, according to a study published in the Journal of the American College of Surgeons. However, the study also showed less robust improvements in efficiency and timing of post-surgical therapy.

Thirty-two states and the District of Columbia have expanded Medicaid coverage since the passage of the Affordable Care Act (ACA) in 2010. “What we learned is that the expansion of some form of third-party coverage for healthcare leads to people doing more things that are intrinsically good for their health,” said senior study author Hiram C. Polk, MD, FACS, division of surgical oncology, University of Louisville, in a press release from the American College of Surgeons.

The authors of the study used the Kentucky Cancer Registry for all women aged 20 to 64 who were diagnosed with breast cancer between 2011 and 2016. Demographics, tumor, and treatment characteristics were assessed for each year during the time frame. The authors then compared 2011-2013 (pre-expansion) to 2014-2016 (post expansion) to determine the association between Medicaid expansion and these factors, as well as quality metrics.

Pre-expansion, 635,547 screening mammograms were performed in Kentucky, compared to 680,418 post expansion; there were 208,600 screening mammograms performed in 2011 alone, compared to 234,315 in 2016. In addition to the amount of screening mammograms performed, the number of screening mammograms covered by Medicaid increased from 5.6% pre-expansion to 14.7% post expansion. The number of uninsured women who had screening mammograms declined almost 10-fold, from .53% to .05%.

The rates of breast-conserving surgery also increased significantly after expansion, from 44% to 48.8%, whereas rates of other resections, such as mastectomy, declined from 50.5% to 44.5%.

While breast cancer incidence and treatment rates did not vary substantially from year to year, the changes in the rates of early-stage versus late-stage disease did; early stage breast cancers accounted for 64.5% of diagnoses pre-expansion versus 66.7% post expansion, and diagnosis of late-stage cancer decreased from 15% pre-expansion to 12.9% post expansion.

However, results also showed that while the time from diagnosis to operation increased post expansion, from 28.6 days to 36 days, the time from operation to chemotherapy remained unchanged, and time from operation to radiation decreased from 96.4 days to 91.5 days.

“The expansion of Kentucky Medicaid in 2014 has been associated with earlier diagnosis and somewhat improved quality of breast cancer care, despite a stable disease incidence,” concluded the authors. “Additional improvements in treatment expediency will require improvements in patient outreach and healthcare infrastructure.”

Reference

Ajkay N, Bhutani N, Huang A, et al. Early impact of Medicaid expansionand quality of breast cancer care in Kentucky [published online February 12, 2018]. J Am Coll Surg. doi: 10.1016/j.jamcollsurg.2017.12.041.