Study Doubts Impact of Pre-ACA Medicaid Expansion on Access to Cancer Surgery

Expansion of Medicaid coverage prior to the authorization of the Affordable Care Act (ACA) in 2010 reduced the uninsured rate in New York State, but did not improve access to cancer surgery.

Expansion of Medicaid coverage prior to the authorization of the Affordable Care Act (ACA) in 2010 reduced the uninsured rate in New York State, but did not improve access to cancer surgery, according to a new study published in the Journal of the American College of Surgeons.

New York state experimented with state-wide Medicaid expansion in 2001. The authors of this study investigated how this expansion affected utilization of surgical care among enrollees. They were particularly interested in finding out if utilization improved in the minority population.

An inquiry on the state’s inpatient database, for the period between 1997 and 2006, identified 67,685 non-elderly adults (18 to 64 years) who underwent cancer surgery. The authors of the study then examined the effect of the 2001 on the payer mix, overall utilization off surgical services, and utilization by racial and ethnic minorities.

The observed outcome was an increase in Medicaid-covered surgeries, from 8.9% to 15.1% during the 5-year period following Medicaid expansion. There was a significant drop in the percent of uninsured individuals (21.3%, P = .01). While Medicaid saw a 24-case per year increase in case volume, the overall all-payer net case volume maintained status quo. Moreover, there was no difference in the percentage of ethnic minorities who were enrolled in Medicaid and received cancer surgery.

“There was a sharp decrease in the uninsured, but the proportion of the racial minority patients undergoing cancer surgery through Medicaid—about 25% African Americans and 13% Hispanic—did not change,” explained Waddah B. Al-Refaie, MD, FACS, surgeon-in-chief at Georgetown Lombardi Comprehensive Cancer Center and chief of surgical oncology at MedStar Georgetown University Hospital. Al-Refaie is the lead investigator on the study.

The researchers are now evaluating the data to understand why Medicaid expansion did not impact the minority population.

“It will be years before this type of evaluation can be done for the ACA-related Medicaid expansion, and we believe these findings should help open a dialogue about what could be done to uncover and improve potential inadequacies of this policy change,” said Al-Refaie.

Reference

Al-Refaie WB, Zheng C, Jindal M, et al. Did pre-Affordable Care Act Medicaid expansion increase access to surgical cancer care? [published online 24 January, 2017]. J Am Coll Surg. doi: http://dx.doi.org/10.1016/j.jamcollsurg.2016.12.044.