Medicaid Expansion Led to Earlier Stage at Diagnosis of Testicular Cancer

With Medicaid expansion beginning in 2014 under the Affordable Care Act (ACA), there was a reduced rate of uninsured patients at the time of diagnosis and a shift to earlier stage at time of diagnosis for patients with testicular cancer in states that adopted expansion, according to findings presented at the 2018 Genitourinary Cancers Symposium.

“We all know insurance status is a key determinant of cancer outcomes,” said Xinglei Shen, MD, radiation oncologist, University of Kansas Medical Center. “People who don’t have insurance do poorly, and the ACA sought to improve outcomes by improving access to insurance.”

Shen and his co-author hypothesized that Medicaid expansion would lead to earlier diagnosis and more guideline concordant treatment for patients with testicular cancer. They looked at the Surveillance, Epidemiology, and End Results (SEER) data from 2010-2014, which provides information on cancer statistics, and identified 12,731 cases of testicular cancer during the time period. The time frame of 2010-2013 was used as the pre-expansion group.

The expansion states included in the analysis were California, Connecticut, Hawaii, Iowa, Kentucky, Michigan, New Jersey, New Mexico, and Washington. Non-expansion states included Arkansas, Georgia, Louisiana, and Utah.

Looking at Medicaid enrollment numbers for the SEER states that did not have expansion, there was a modest increase in the amount of people on Medicaid, while there was a pretty robust increase in the number of people enrolled in expansion states, said Shen. The biggest change was seen in New Mexico, with a 50.3% increase.

For insurance status at time of diagnosis, they found that in expansion states, there was a pretty significant drop in patients who were uninsured at the time of diagnosis, from 8.7% to 4.3%. In non-expansion states, there were no significant changes, according to Shen. The proportion of people enrolled in Medicaid increased from 14.8% to 19.4%.

There was also an effect on the stage at diagnosis. In states that expanded Medicaid, 20.2% of patients had stage 3 cancer at the time of diagnosis, down from 27.1% before expansion. There was also a corresponding increase in the proportion of patients diagnosed at stage 1, according to Shen. For states that did not expand, 29.2% of patients had stage 3 cancer at the time of diagnosis, up from 23.2% before 2014.

Lastly, they look to see if there was an effect on quality of care, but the results did not indicate a significant difference.

Shen concluded by indicating that longer-term follow up is needed to study how Medicaid expansion would affect cancer outcomes and survival.