Following Medicaid Expansion, Racial Disparity Increased for Those Seeking Cancer Treatment

Study authors say increased Medicaid access and coverage not associated with better health outcomes

Eighteen-year-old cancer patient receiving chemotherapy treatment / Getty Images
October 10, 2017

Following Medicaid expansion in New York, racial disparity increased for those seeking cancer treatment, according to a study from the Journal of American College of Surgeons.

"The Affordable Care Act's (ACA) Medicaid expansion has been heavily debated due to skepticism of Medicaid's ability to provide high-quality care," the authors explain. "Particularly, little is known whether Medicaid expansion improves access to surgical cancer care at high-quality hospitals. To address this question, we examined the effects of the 2001 New York Medicaid expansion, the largest in pre-ACA era, on this disparity measure."

Researchers evaluated 67,685 patients that were 19 to 64 years old and had one of 9 types of procedures for cancer treatment including lung, bladder, rectum, colon, kidney, liver, pancreas, stomach, and esophagus cancer. These types of cancer were evaluated because they have a higher risk for mortality and morbidity.

Researchers said they wanted to evaluate racial disparity because African-American patients are more likely to be uninsured and could possibly benefit most from the expansion of Medicaid. In addition, the proportion of minority patients covered did not significantly increase under New York's Medicaid expansion in 2001.

Of the 67,685 patients that doctors evaluated, 15 percent were either uninsured or were covered by Medicaid, 12 percent were African-American, and 67 percent were white.

The study found that before Medicaid began expanding in New York, the racial gap was declining. After Medicaid was expanded, however, the racial gap widened.

"Disparity in access to high-volume hospitals for surgical cancer care between African-American patients and non-Hispanic white patients was decreasing by 0.43 percentage points per quarter in the pre-expansion period," the authors explain. "Over the 21-month post-expansion observation, the increase accumulates to 18.3 percentage points. Racial disparity in access to low-mortality hospital shows a similar pattern, decreased briefly at the time of the expansion by 5.6 percentage points, but increasing following expansion by 0.48 percentage points per quarter."

In conclusion, researchers say that Medicaid expansion in New York led to increased racial disparity for surgical cancer care and that non-Hispanic white Medicaid beneficiaries may have had an easier time getting cancer care.

"It has been widely reported that Medicaid coverage expansion has improved access to a variety of health care services, including primary care, subspecialty surgical care, and surgical cancer care," the authors explain. "However, increased coverage and care utilization has not been shown to be strongly associated with better health outcomes."

"There has also been literature suggesting expanded Medicaid coverage generated no significant improvements in physical health outcomes despite the increase in utilization of health care services," the authors said.

According to Waddah B. Al-Refaie, M.D., the study's lead investigator, while New York's Medicaid expansion increased access, it did not benefit ethnic and racial minorities.

"This study shows that New York’s Medicaid expansion, one of the largest in U.S. history before the Affordable Care Act, improved access to cancer surgery for the previously uninsured," he said. "However, it did not appear to preferentially benefit ethnic and racial minorities who are typically the most vulnerable of America’s poorest population."

"There was a sharp decrease in the uninsured, but the proportion of the racial minority patients undergoing cancer surgery through Medicaid—about 25 percent African American and 13 percent Hispanic—did not change," explains Al-Refaie.

Published under: Medicaid , New York