Inconsistent Medicaid expansion would widen disparities in screenings for women's cancers

Low-income and uninsured women in states that are not expanding their Affordable Care Act (ACA) Medicaid coverage are less likely to receive breast and cervical cancer screenings compared to states that are implementing expansions. This research was published in the American Journal of Preventive Medicine (2015; doi:10.1016/j.amepre.2014.08.015).

The ACA is allowing states to extend their Medicaid health insurance coverage for nonelderly adults with an annual income up to 133% of the federal poverty line. However, only approximately half of the states are expanding their Medicaid eligibility.

"I was interested in what the Medicaid expansion means in socioeconomic terms," said lead author Lindsay Sabik, PhD, a member of the Cancer Prevention and Control research program at Virginia Commonwealth University Massey Cancer Center in Richmond.

In the study, Sabik and colleagues looked at the potential impact of the ACA on women's cancer screenings for low-income and uninsured populations in the states implementing expansion and the states that are not.

Using pre-ACA, self-reported data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS), the team analyzed differences of income, race, and ethnicity for women ages 52 to 64 years who followed US Preventive Services Task Force guidelines and underwent mammography within 2 years, and women ages 24 to 64 years who followed the task force's recommendations and had Pap tests performed within 3 years. The BRSS is a telephone survey conducted in all 50 states by the US Centers for Disease Control to collect public health data.

The researchers found that women who do not have health insurance are significantly less likely to undergo regular mammography and Pap tests. The study results suggest that uninsured women in nonexpansion states are less likely to receive potentially lifesaving breast and cervical cancer screenings by 7.9% and 4.9%, respectively.

Sabik pointed out that as Medicaid coverage expands and women in nonexpansion states, who are more likely to be low-income and African American than in expansion states, continue to lack health insurance coverage, the disparities in breast and cervical cancer screenings may continue to widen.

Sabik advised that nonexpansion states should pay attention to existing disparities in preventive care across populations. She suggested that officials consider the costs and benefits of Medicaid expansion for these groups and whether the expansion might narrow the gap in coverage for potentially life-saving breast and cervical screenings.

"There's a lot that still needs to be done to make the Medicaid program more consistent across states to give all women fair access to cancer screenings," added Sabik, who is also an assistant professor of Healthcare Policy and Research at the VCU School of Medicine.

Sabik is currently working on a National Cancer Institute-funded Medicaid policy research study on breast and cervical cancer screenings for low-income women. In that study, she is looking into Medicaid administrative data as well as cancer registry data across states to determine how Medicaid impacts these screenings for low-income women and to determine any racial and ethnic differences in treatment.

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