States that expanded their Medicaid programs as a result of the Affordable Care Act (ACA) saw greater increases in screening for colorectal cancer (CRC) and breast cancer compared with states that didn’t expand their insurance program for the poor, according to research published recently in the American Journal of Preventive Medicine.
“Health insurance is a strong predictor of cancer screening, and the uninsured and those with lower socioeconomic status are more likely to be diagnosed at late stage and die from screen-detectable cancers, including colorectal cancer,” said Stacey Fedewa Ph.D., senior principal scientist in the Surveillance and Health Services Research department at the American Cancer Society in a press release.
Fedewa and her colleagues used 2012, 2014, and 2016 data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey overseen by the Centers for Disease Control and Prevention (CDC). They examined these data to look for temporal changes in screening patterns among low-income adults in all 50 states.
Between 2012 and 2016, the proportion of low-income adults ages 50 to 64 who were up-to-date with CRC screening grew by 8.8 percentage points in very early adopter states (from 42.3% to 51.1%); by 2.9 percentage points in early adopters (from 49.6% to 52.5%); and by 3.8 percentage points in non-expansion states (from 44.2% to 48.0%).
The magnitude of this change was greatest in very early adoption states versus the non-expansion states. In total, the researchers estimated that an additional 236,573 low-income adults receiving recent CRC screening in 2016 in very early adoption states. It further estimated that had the same absolute increase occurred in non-expansion states, 355,184 more low-income adults would have had recent CRC screening.
The authors of the study also noted that CRC screening rate increased in the states that expanded Medicaid early did not happen immediately, likely reflecting the lag between getting health insurance, having a physician visit and then a referral to a specialist for the screening.
Because of this the authors noted that “it is likely that the full impact of Medicaid expansions on cancer screening may not yet be fully visible and the previously reported modest improvements in early stage at diagnosis for screening detectable cancers could progress further.”