Medicaid and Cancer Surgery

A recent study of New York State’s expansion of access to care reveals unexpected results.

An analysis of the New York State’s Medicaid expansion, which predated the 2010 Affordable Care Act, finds substantial decrease in uninsured rate but little change in racial disparities when it comes to cancer surgery access—a proxy for complex cancer care.

The results, published in the Journal of the American College of Surgeons, found that the Medicaid expansion significantly improves access to surgical cancer care overall, but the proportion of minorities having surgery, relative to whites, did not change—an unexpected finding.

The researchers from Georgetown University and MedStar Health representing medical research, policy, and law, say their findings may provide timely and meaningful insight into what could result from the expansion of Medicaid, a state and federal program that provides health insurance for those with very low income. The expansion has already occurred in 31 states and the District of Columbia as part of ACA.

“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. However, it did not appear to preferentially benefit ethnic and racial minorities who are typically the most vulnerable of America’s poorest population,” explains the study’s lead investigator, Waddah B. Al-Refaie, MD, surgeonin- chief at Georgetown Lombardi Comprehensive Cancer Center and chief of surgical oncology at MedStar Georgetown University Hospital.

“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.

In fact, they found that the proportion of minorities relative to whites who received cancer surgeries was unchanged in New York before and after the Medicaid expansion.

The researchers say additional analysis now underway might help explain why the proportion of minority use did not change after the expansion, which was designed to mirror socioeconomic status in New York. They say it could be due to a number of factors such as selective referral patterns, “minority crowd-out” (where non-minority patients displace minority patients), hospital reimbursements, or insurance contracting.

“From establishing a need for cancer surgery to actually having the surgery involves many steps, and it is a complicated process to unravel,” Al-Refaie says.