A new study shows that Medicaid expansion correlates with lower cancer mortality rates. Evan Graboyes, M.D., an MUSC Hollings Cancer Center head and neck surgical oncologist, Cancer Control Program researcher and one of the authors of the study, said this is the first time researchers have studied the impact Medicaid expansion has on cancer mortality.
“Through this study, we estimate that over 5,000 cancer deaths were prevented during the study period in early Medicaid expansion states,” Graboyes said.
The study, which was published in the Journal of the National Cancer Institute, obtained county-level data from the National Center for Health Statistics for adults between the ages of 20 and 64 who died from cancer between 2007 and 2009 and 2012 to 2016. Researchers then compared mortality rates in states that expanded Medicaid with those that didn’t. South Carolina remains one of 11 states that hasn’t expanded Medicaid.
“We wanted to look at changes over time because we expected advancements in cancer care were made whether the state expanded Medicaid or not,” Graboyes said. “By comparing mortality rates in this way, we were able to measure whether expanding Medicaid affected cancer mortality, and we found that it did.”
While both expansion and nonexpansion states saw overall cancer mortality rates drop, expansion states, with 64.8 cancer deaths per 100,000 people, had a lower mortality rate than nonexpansion states, with 79.4 cancer deaths per 100,000 people.
One of the notable findings involved mortality rates in pancreatic cancer in expansion states versus nonexpansion states. From 2007 until 2016, pancreatic mortality rates in states that expanded Medicaid decreased from 4.47 deaths per 100,000 people to 4.22 deaths. However, in states that didn’t expand Medicaid, pancreatic mortality rates increased from 4.72 deaths per 100,000 to 4.87 deaths.
“This is important because cancer types like pancreatic have a poor prognosis overall,” he said. “These are areas researchers are especially interested in studying to improve overall patient outcomes.”
“This is important because we spend so much time and effort coming up with new drugs and treatments to improve patient outcomes. This study shows that there are simpler things — like giving someone better access to care — that can also aid in saving lives.”
— Dr. Evan Graboyes
Researchers also found that the mortality rates for breast, cervical and prostate cancers were lower in states that had expanded Medicaid.
“This is the first study to show that Medicaid expansion decreases the risk of dying from cancer,” Graboyes said. “This is important because we spend so much time and effort coming up with new drugs and treatments to improve patient outcomes. This study shows that there are simpler things — like giving someone better access to care — that can also aid in saving lives.”
Hollings lung cancer researcher Gerard Silvestri, M.D., found similar findings summarized in a paper published in the May issue of Health Affairs. In that study, researchers found that insurance status affects cancer outcomes more than age.
“The results of this study led me to ask this simple question: ‘Is it OK for a patient to die from cancer simply because he or she does not have health insurance?’ If the answer is ‘no’ to that question, then a true policy discussion needs to happen at a high level,” Silvestri said.
Graboyes said the new study shows that there is still work to be done to improve cancer outcomes. The study’s senior author, Nosayaba Osazuwa-Peters, Ph.D., assistant professor at the Duke University School of Medicine and a member of the Duke Cancer Institute, said while Medicaid expansion did improve survival, it alone isn’t the solution.
“It is important to stress that Medicaid expansion is not the silver bullet or the panacea to the problem of health disparities and social determinants of health that has plagued cancer survivorship for so long,” Osazuwa-Peters said. “We hope that when people examine Medicaid expansion or the Affordable Care Act that they see that its implications could be more than just preference or choice. It could be a matter of life and death for some cancer survivors.”
The study furthers Graboyes’ research on the impact of health insurance on cancer patients. Graboyes was involved in a 2020 study published in JAMA Otolaryngology–Head & Neck Surgery that examined the effects of Medicaid expansion on head and neck cancer patient care. Graboyes found that in states that expanded Medicaid as part of the Affordable Care Act, patients with head and neck cancer were more likely to be diagnosed with localized — stages I to II — cancer and initiate treatment in a timelier fashion than patients in nonexpansion states. Because of the strong association with a particular stage at diagnosis and the timely treatment that leads to survival for head and neck cancer, the study suggests that Medicaid expansion that offers insurance coverage may help to improve outcomes for patients with head and neck cancer.
Osazuwa-Peters said the new study supports the case for further detailed studies into the topic. “Medicaid expansion is unique in the sense that different states have expanded at different times, while others, including North and South Carolina, haven’t expanded at all,” he said. “The evolution of Medicaid expansion in itself sets the stage for a natural experiment playing out on the national health policy stage.”
Graboyes agrees that more studies are needed to follow up on the results of the initial research and increase the understanding of how the expansion of Medicaid has affected patients with cancer.
“This new study really expands our knowledge of how expansion affects all different types of cancer,” Graboyes said. “These patients are someone’s mother, father, sister, brother and friend. These are real lives at stake, which is what will continue to drive this research forward.”