Substantial State Variations Identified in Health Insurance Coverage at Cancer Diagnosis

Substantial variations in Medicaid coverage and uninsured rates seen in a recent study suggest that many patients with cancer may face challenges receiving continuous care, which could have consequences as the COVID-19 pandemic protections for Medicaid coverage end.

This nationwide population-based study is published in Health Affairs Scholar.¹

“Having health insurance coverage is crucial to ensure timely access to quality cancer treatment and survivorship care,” Xuesong Han, PhD, scientific director, health services research at the American Cancer Society (ACS) and senior author of the study, said in a statement.² “The findings reinforce the importance of the expansion of Medicaid income eligibility under the Affordable Care Act, playing a big role in access to care and helping to save lives.”

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In this study, researchers identified 6,432,117 incident cancer cases with known insurance status diagnosed at ages 18 to 74 years from 49 population-based state registries, using data from the Cancer Incidence in North America registry from 2010-2019.

The researchers grouped states into categories according to expansion: states that adopted and implemented Medicaid expansion by 2014 (n = 26), late-expansion states between 2015 and 2019 (n = 7), and nonexpansion states as of 2019 (n = 16).

The main outcome was primary insurance coverage type at diagnosis (Medicaid, other insurance, or uninsured), as well as trends of the annual percentage of incident cancer cases with Medicaid coverage and those uninsured at diagnosis by expansion status for each individual state.

Among the patients with incident cancer cases, 993,695 had Medicaid and 340,055 were uninsured at diagnosis. Additionally, there were 3,448,747 cases diagnosed in expansion states, in which Medicaid coverage increased immediately after the implementation of the Affordable Care Act by 3% from 15.8% in 2013 to 18.9% in 2014, then continued to increase to 19.9% in 2019.

Meanwhile, the rate of Medicaid coverage remained lower at 12.5% in nonexpansion states. Furthermore, the uninsured rate decreased from 4.9% to 2.1% in expansion states, while the uninsured rate decreased slightly from 9.5% to 8.1% in nonexpansion states.

In 2019, there were 11,393 patients with new cancer cases, of whom 16.9% had Medicaid coverage at diagnosis, although this ranged from 7.6% to 37.9% across states. Additionally, 48,357 (4.4%) of these patients were uninsured, ranging from 0.5% to 13.2%.

The implications of these findings suggest the importance of state-based cancer prevention and control efforts to help mitigate the burden of cancer care access disparities, especially among vulnerable patient populations.

“This study is further proof that expanding Medicaid increases access to comprehensive health insurance and we know that alone can increase the chances that cancer is diagnosed early which in turn augments the likelihood that someone survives the disease. In short, expanding this health insurance program is saving lives,” Lisa Lacasse, president of ACS Cancer Action Network (CAN), said in a statement.² “ACS CAN has been a long-time advocate for Medicaid expansion to reduce the cancer burden and continues to work tirelessly in the 10 states that have not yet increased their Medicaid program eligibility.”

References

1. Hu X, Yang NN, Fan Q, Yabroff KR, Han X. Health insurance coverage among incident cancer cases from population-based cancer registries in 49 US states, 2010–2019. Health Affairs Scholar. 2024;2(1). doi:10.1093/haschl/qxad083

2. New study shows substantial state variations in health insurance coverage at cancer diagnosis in the US. American Cancer Society MediaRoom. January 11, 2024. Accessed January 11, 2024. https://pressroom.cancer.org/releases?item=1292