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Medicaid expansion decreased racial disparity in cancer care, study shows

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Nurse Caitlin Fanning (left) inserts an IV for Judith Bernstein’s chemotherapy at the Fox Chase Cancer Center in Philadelphia. File

States that accepted federal money to expand eligibility for the low-income Medicaid program are seeing improvements in cancer care disparities between white and black patients, according to a recent study. 

“When people have access to proper health care ... they are going to have better health outcomes than people who didn’t have this access," said Dr. Marvella Elizabeth Ford, the associate director of population sciences and cancer disparities at the Medical University of South Carolina's Hollings Cancer Center.

Flatiron Health, a health care technology company, collaborated with investigators at Yale University and recently asked researchers to look into what percentage of nearly 20,000 patients received chemotherapy within a month of a cancer diagnosis. 

More than 11,000 were in states that chose to expand Medicaid — an optional provision of the Affordable Care Act.

In states that did not expand, the study found there was a nearly 5 percentage point difference between white and black patients who received chemotherapy within a month of their cancer diagnosis. 

In states that did expand, the difference drops to a 0.8 percentage point difference between the two races. 

“Many studies have described racial disparities that exist in cancer care, but few have shown what types of interventions improve health equity,"  Dr. Amy J. Davidoff, the study author and the Senior Research Scientist in Health Policy and Management at the Yale School of Public Health, said in a press release. 

"We now have evidence that Medicaid expansion can mitigate certain health disparities." 

Ford said that while the findings aren't surprising, the implications are unfortunate. With chemotherapy, she explained, timing is often an important factor. 

“If you delay that time of initiation ... it can reduce the effectiveness of the treatment," she said. 

In an article published by STAT, researchers emphasized that the study participants were a snapshot of all white and black patients who were in Flatiron's system. 

Ford explained past studies that have shown similar results. A 2017 study by Health Affairs found that Medicaid expansion led to increased health care access for Americans who were unemployed or live in a low-income household.

Another study found that Medicaid expansion narrowed disparities among whites, blacks and Hispanics

Dr. Saundra Glover, the director of Institute for Partnerships to Eliminate Health Disparities at the University of South Carolina, said she and her colleagues expected to see results like the Flatiron study. Access to health care services, she explained, plays a big role in health outcomes.

She said she hopes to see more studies on all aspects of health, not just cancer. When that happens, she said she anticipates similar disparity-erasing results.  

“I certainly think that this is preliminary evidence that the expansion results in positive outcomes," she said. “This would have a significant impact on South Carolina.”

South Carolina is one of 14 states that has chosen not to expand Medicaid, according to the Kaiser Family Foundation. The Centers for Disease Control and Prevention ranks South Carolina as having the 11th highest cancer death rate among all 50 states. 

Ford explains that since there is a large portion of SC that is economically disadvantaged, that impacts health outcomes, too. 

“The geographic disparities affects all of us," she said. “Some of us may be buffered by income.”

Health care affordability is important, she explained. But she believes a conversation on coverage and Medicaid expansion is just step one. 

“I can just say the data speaks for itself.

“Insurance alone can’t address all of the issues," she said, "but it’s a large component."

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Reach Jerrel Floyd at 843-937-5558. Follow him on Twitter @jfloyd134.