How will Medicaid expansion under the Affordable Care Act (ACA) change cancer survivors' access to healthcare? Answering the question first requires defining access to healthcare before the ACA. An analysis published in the Journal of Cancer Survivorship finds that even in the landscape before the ACA, cancer survivors in states that had already expanded Medicaid coverage prior to the ACA had more access to healthcare than cancer survivors in states that had not expanded Medicaid.
"Populations most affected are the low-income and uninsured. If cancer survivors cannot get the follow-up care they need, recurrences may be missed and long-term consequences of cancer treatment may not be appropriately managed," says Cathy J. Bradley, PhD, associate director for Population Science at the University of Colorado Cancer Center, professor in the Colorado School of Public Health, and one of the paper's authors.
The study used data from the 2012 and 2013 Behavioral Risk Factor Surveillance System, which collects annual health data of over 400,000 people living in the United States. Specifically, the study looked at whether cancer survivors across states had personal doctors, received an annual checkup, and reported inability to see a doctor because of cost.
Again, even in the healthcare landscape as it existed before the ACA, cancer survivors in states without expanded Medicaid were less likely to have a personal doctor and more likely to report inability to see a doctor due to cost (odds ratios 0.76 and 1.14 respectively). The study controlled for other possible factors that could determine access.
"The reasons for these disparities were outside the scope of the current study, but my guess is that non-expansion states have higher uninsurance rates and more stringent eligibility criteria for their existing Medicaid programs," Bradley says.
"While cancer survivors are at high risk of developing other cancers and experiencing late effects of treatment, our findings imply that survivors living in non-expansion states are less likely to access health care services that are necessary to receive the care they need," the paper writes.
According to Bradley, the paper shows that increased access to Medicaid benefits low-income cancer survivors. The study sets the stage for continuing analysis of healthcare access and health outcomes for cancer survivors in the era of the Affordable Care Act.