Association Between Medicaid Expansion and Insurance Status, Risk Group, Receipt, and Refusal of Treatment Among Men...

Area of Science:

• Health Services Research
• Oncology
• Health Policy

Background:

• The Patient Protection and Affordable Care Act (ACA) expanded Medicaid, potentially improving healthcare access for prostate cancer patients.
• Previous research indicates increased Medicaid coverage post-ACA, but its impact on specific prostate cancer treatment pathways and disparities requires detailed analysis.

Purpose of the Study:

• To investigate the association between Medicaid expansion and prostate cancer patient outcomes, including diagnosis risk group, time to treatment initiation (TTI), and locoregional treatment (LT) refusal.
• To examine how Medicaid expansion affects racial disparities in these outcomes among prostate cancer patients.

Main Methods:

• Retrospective cohort analysis of 112,434 localized prostate cancer patients aged 40-64 from the National Cancer Database (2011-2016).
• Difference-in-difference (DID) analysis comparing outcomes in Medicaid expansion vs. non-expansion states.
• Secondary DID analysis comparing racial minorities vs. White patients within expansion states.

Main Results:

• Medicaid expansion states saw significant decreases in uninsured patients and radiation therapy refusal compared to non-expansion states.
• Racial disparities narrowed for uninsured status and radiation therapy refusal in expansion states; however, racial disparities in TTI worsened.
• Medicaid expansion was not significantly associated with changes in diagnosis risk group, TTI, or LT refusal.

Conclusions:

• While ACA's Medicaid expansion improved insurance coverage and reduced radiation therapy refusal for prostate cancer patients, its effect on treatment timeliness and locoregional treatment refusal remains unclear.
• The impact of Medicaid expansion on prostate cancer outcomes and disparities is complex, with some disparities narrowing but others, like TTI, exacerbating.
• Further research is necessary to understand the nuanced effects of Medicaid expansion on diverse patient populations and cancer care.