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 In Massachusetts, after the state expanded access to health
insurance, patients with these cancers were more likely than
patients in other states to get needed surgery and to get it before
their condition grew dire, the study found.
The study "provides cautiously optimistic evidence that expanding
insurance doesn’t just increase access to healthcare but also
increases the receipt of care and optimal care for a common cancer,"
said lead author Dr. Andrew Loehrer, who worked on the study while
at the Codman Center for Clinical Effectiveness in Surgery at
Massachusetts General Hospital in Boston.
In 2006, under then-governor Mitt Romney, Massachusetts overhauled
its healthcare system by expanding access to Medicaid, the state and
federal insurance for the poor. The state also created a new
insurance program for people not eligible for Medicaid and required
all residents to be covered by a plan.
The overhaul was a model for the national 2010 Affordable Care Act (ACA),
which created insurance marketplaces in each state, mandated
coverage and encouraged states to expand their Medicaid programs.
There are currently 19 states that haven't expanded Medicaid access,
however.
“As 19 states have yet to expand Medicaid in a similar way that
Massachusetts has, evaluating the impact of that on a very common
and deadly cancer remains important," said Loehrer, who is now at MD
Anderson Cancer Center in Houston, Texas.
Colorectal cancer is the third most common cancer for both sexes and
the second leading cause of cancer death in the U.S., according to
the Centers for Disease Control and Prevention.
For the new study, the researchers compared hospital data collected
from 2001 through 2011 on 17,499 colon cancer patients in
Massachusetts and 144,253 more patients in New York, New Jersey and
Florida - three states that didn't expand insurance access during
that time.
Compared to colon cancer patients in the states without expanded
insurance access, the patients with government-subsidized insurance
or self-pay insurance in Massachusetts after the expansion had a 44
percent increase in surgeries to remove the cancer.
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“I certainly cannot say with this study that the insurance expansion
increased survival from cancer," Loehrer said. "What I can say is it
was associated with an increase in surgery, and we know that surgery
plays an important role in survival.”
Additionally, the researchers report in the Journal of Clinical
Oncology, after the Massachusetts law took effect, there was a
roughly 6 percentage point decrease in the likelihood that colon
cancer patients would need emergency surgery as well as an 8
percentage point increase in the probability that their surgery
could be planned in advance.
"Colon cancer is an important test case," Dr. Benjamin Sommers, of
the Harvard T.H. Chan School of Public Health in Boston, told
Reuters Health.
The study looked at a very specific condition that may be responsive
to more timely care and found people are more likely to get the
treatment they need after insurance expansion, said Sommers, who was
not involved with the new study.
It's difficult to know how the results apply to other states, he
said, because Massachusetts is a high-income state with a lot of
doctors. While many states that expanded Medicaid under the ACA
aren't in the same position, those states likely have an even
greater need for expanded coverage.
It’s hard to know which of those effects - Massachusetts' larger
number of doctors, or other states' need for broadened access to
care - will be bigger, he said.
SOURCE: http://bit.ly/2dfzw9f Journal of Clinical Oncology, online
October 3, 2016.
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