News & Commentary

ACA Decreased Racial Disparities


The American Society of Clinical Oncology’s annual meeting had a slightly different twist this year. Usually the meetings, the largest gatherings of cancer doctors in the world, focus on studies of the latest cancer treatment. This year’s meeting, held in Chicago in early June, certainly featured plenty of treatment studies but also put the importance of insurance coverage front and center.

For example, one of the four studies at the meeting’s plenary session showed an association between Medicaid expansion and a major improvement in timely treatment of advanced or metastatic solid tumors. Timely treatment was defined as starting first-line treatment within 30 days of a diagnosis for advanced or metastatic cancer.

“I think the take-home message … is really about access to care,” said Richard L. Schilsky, MD, ASCO’s chief medical officer at a June 2 press briefing. “If you can’t get care, you can’t benefit from all the advances in cancer treatment that are being recorded every year at the ASCO annual meeting.”

Yale researchers sifted through de-identified health records provided by Flatiron Health, which funded the study. They winnowed their search down to roughly 30,000 adult cancer patients, ages 18 to 64, 12% of whom were African-American.

When they compared patients in expansion states to those in non­expansion states, they found that Medicaid expansion had a disproportionate effect on timely treatment of African-Americans (a 6.1 percentage point improvement vs. 1.8 for whites). The difference meant that racial disparity in timely treatment effectively disappeared in expansion states.

“We now have evidence that Medicaid expansion can mitigate certain health disparities,” said Amy J. David­off, a health economist at the Yale School of Public Health and one of the study’s authors.

The study had limitations; it did not, for example, correct for the economic status of patients. Also, the Medicaid expansion versus nonexpansion comparison was made at the state level. The study did not reach down to the level of whether individual patients were covered by Medicaid.

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