The big question surrounding the ACA, the landmark 2010 healthcare legislation better known as Obamacare, is whether the country can afford it. While the healthcare law remains controversial, two new studies out of Yale University and Johns Hopkins University now suggest that Medicaid expansion, a key component of the ACA, has helped bring better parity to cancer treatment in the United States, suggesting that the law may have brought unexpected benefits to millions of patients who have been traditionally underserved in the healthcare realm.
While Congress has now publicly stated a Republican-sponsored healthcare bill will not hit the Senate floor until 2020 at the earliest, the Trump administration is still attempting to repeal the ACA through the courts. While critics of the ACA claim the legislation, particularly its call for Medicaid expansion, have resulted in an undue financial burden on the states, 36 states and the District of Columbia have adopted the expansion to date. The result is an additional 13.6 million Medicaid enrollees in those expansion states—a number which seems to suggest prohibitive costs unless patient outcomes can be proven to be significantly improved. Yet, Blythe Adamson, PhD, MPH, a senior quantitative scientist at Flatiron Health in New York, says that economists were having difficulty determining whether Medicaid expansion was actually having any impact on health outcomes.
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“At the time, most people didn’t have data recent enough to know the impact,” she says. “But, at Flatiron, I knew we had more recent data, with clinical depth of outcomes, that afforded us a unique opportunity to take a look and try to answer this question, particularly in the case of cancer treatment.”
Adamson, Amy Davidoff, PhD, a senior research scientist at Yale Cancer Outcomes, and colleagues analyzed more than 30,000 health records to look at how expansion had affected cancer treatment after an advanced or metastatic cancer diagnosis. Previous research had uncovered that black adults were 4.8 percent less likely than white adults to start treatment with a few weeks of diagnosis, leading to poorer outcomes and, too often, more expensive care. But, in states that adopted Medicaid expansion in 2014 or thereafter, Adamson and colleagues discovered a boost not only to the number of black adults receiving timely treatment but to white patients as well. Adamson says this study built on previous research by Davidoff who had shown other types of improvements in racial disparities after Medicaid expansion.
“I was surprised by just how dramatic the change was,” says Adamson. “You might expect to see a little bit of change but the racial disparities were practically eliminated after Medicaid expansion. We looked at this very specific moment in time for a patient. But it’s one that is fraught with anxiety. If you’ve just received an advanced cancer diagnosis, and there is uncertainty whether or not you can afford costly first-line therapy drugs or whether they will be covered by your insurance, it’s going to delay time to treatment. So I think we learned, in this study, at this one moment in time, that Medicaid expansion helped reduce the uncertainty that patients could get their treatment covered and, in doing so, made things more equitable.”
The team’s work is further supported by a second, independent study out of Johns Hopkins University, demonstrating improvements in the diagnosis of ovarian cancer, a cancer that can be quite difficult to detect, after Medicaid expansion. The authors of that study concluded that greater access to healthcare has the power to not only improve patient outcomes and save lives—but also help lower healthcare costs when these cancers are caught and treated early.
While Davidoff says it is important to emphasize the results from their study are correlational, not causal—she believes that increased access to health insurance for low income adults can reduce disparities in access to timely healthcare treatment.
“Our study results emphasize the importance of providers to advocate for policies that improve access to high quality and timely care for patients,” Davidoff says. “Outside of the study results, it is important to recognize that insurance is usually necessary, but not sufficient to eliminate race disparities in cancer care, and that providers also need to make greater efforts to assess and reduce practice-level barriers to access for racial minorities and other vulnerable groups.”
Kayt Sukel is a science and health writer based outside Houston.