Data Shows a Decline in Cancer-Related Deaths Following Adoption of the Affordable Care Act

In the first nationwide study assessing the rate of cancer-related deaths following the adoption of the Affordable Care Act (ACA) of 2010, researchers found that states that adopted ACA’s Medicaid expansion saw greater decreases in cancer mortality rates than states that did not.¹

The researchers observed trends for age-adjusted cancer mortality in the United States between the years of 1999 and 2017. The data from these years demonstrated that in the states where Medicaid was expanded following the adoption of the ACA, there was a 29% decline in mortality, falling from 65.1 to 46.3 per 100,000 individuals during that period.¹

However, in states that did not adopt the Medicaid expansion, the mortality rates dropped by 25%, from 69.5 to 52.3 per 100,000 individuals.¹

Based on the data, in 2017 alone, there was an estimated 785 fewer cancer deaths in states that adopted Medicaid expansion.¹

"This is the first study to show the benefit of Medicaid expansion on cancer death rates on a national scale,” said study lead author Anna Lee, MD, MPH, a radiation oncology fellow at Memorial Sloan Kettering Cancer Center, in a press release. “We now have evidence that Medicaid expansion has saved the lives of many people with cancer across the United States.”²

Although the ACA granted states permission to expand Medicaid coverage to more people, Medicaid is administered by individual states, so it needs to be adopted state-by-state. Medicaid offers health care coverage to individuals with disability or low income.¹

In January 2014, many states formally adopted the ACA’s Medicaid expansion. Upon its adoption, these states saw an increase in Medicaid enrollment, with people enrolling who had incomes near the poverty level but were not previously eligible, as well as others who had been eligible but did not yet enroll. By 2017, 27 states plus the District of Columbia had adopted Medicaid expansion, while 23 states had not.¹

The researchers used data for all US residents from the National Center for Health Statistics. By establishing baseline trends between 1999 and 2017, the researchers compared the age-adjusted rates prior to full state expansion (before 2014) and following the expansion (after 2014) in the states that adopted Medicaid expansion and those that did not.¹

However, patients age 65 or older who died from cancer were not included in the researchers’ analysis, as those patients would be eligible for Medicare and would not be enrolled in Medicaid.¹

The researchers also analyzed the data of sub-populations, including patients who were black or Hispanic. Despite large mortality gains during the study period for patients who were black, there was no observed additional mortality reduction in this population in states where Medicaid was expanded. Furthermore, age-adjusted cancer mortality overall was worse for black patients in states that did not expand Medicaid in comparison with states that did (58.5 vs 63.4 per 100,000 for the expansion and non-expansion states respectively).¹

However, among Hispanic patients, there was a significant change in cancer mortality rates between expansion and non-expansion states. Yet, there was also a significant variation observed between the year-to-year mortality rate in this population.¹

“There is a greater Hispanic population in states that have adopted Medicaid expansion, and they have almost 3 times the un-insurance rate as white adults,” said senior author Fumiko Chino, MD, a radiation oncologist at MSK, in a press release. “Our research shows that Hispanic patients with cancer may have benefited the most because they had the most to gain.”²

When approaching the analysis, the researchers used the difference-in-differences statistical technique. This technique required the calculation of the difference in mortality rates between the periods for the expansion and non-expansion states, and then additionally the calculation of the difference between these values. The researchers used this technique in order to mitigate baseline population differences and other differences in access at the state level.¹

The study’s findings will be presented by the researchers at the virtual 2020 American Society of Clinical Oncology (ASCO) Annual Meeting.²

“This study provides needed data to understand the effects of Medicaid expansion on cancer care,” said Richard L. Schilsky, MD, FACP, FSCT, FASCO, chief medical officer and executive vice president of ASCO, in a press release. “Better access to quality cancer care, in this case through state expansion of Medicaid, leads to fewer cancer deaths.”²

REFERENCES

• Lee A, Shah K, Chino JP, et al. Changes in cancer mortality rates after the adoption of the Affordable Care Act [ASCO abstr 2003]. J Clin Oncol. 2020;38(suppl). doi: 10.1200/JCO.2020.38.15_suppl.2003.
• Greater Decline in Cancer-Related Deaths Seen in Medicaid Expansion States in First Nationwide Study [news release]. Alexandria, VA: ASCO; May 13, 2020. asco.org/about-asco/press-center/news-releases/greater-decline-cancer-related-deaths-seen-medicaid-expansion. Accessed May 29, 2020.