Association of Medicaid Expansion With the Presentation and Management of Genitourinary Cancers

Medicaid expansion was associated with a decreased uninsured rate, an increased proportion of early-stage diagnosis for kidney and prostate cancers, and an increased proportion of patients receiving active surveillance for low-risk prostate cancer in a recent study (JAMA Netw Open. 2021;4[5]:e217051. doi:10.1001/jamanetworkopen.2021.7051.).

Katharine F. Michel, MD, MSHP, University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues, assessed the association of Medicaid expansion with health insurance status among patients with genitourinary cancer.

“Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer,” wrote Dr Michel and colleagues.

The National Cancer Database was used to select patients with a new primary diagnosis of kidney, bladder, or prostate cancer between January 2011 and December 2016. A total of 340,552 patients aged 18 to 64 years were included. Of these patients, 27.6% had kidney cancer, 7.6% had bladder cancer, and 64.8% had prostate cancer.

The case group consisted of patients in states that expanded Medicaid, while the control group consisted of patients in nonexpansion states. Analysis occurred between January 2020 and March 2021.

When compared with the control group, the case group was associated with a net decrease in uninsured rate of 1.1 (95% CI, −1.4 to −0.8) percentage points across all incomes and a net decrease in the low-income population of 4.4 (95% CI, −5.7 to −3.0) percentage points.

Expansion was associated with a significant shift toward early-stage diagnosis in kidney cancer across all income levels (difference-in-difference, 1.4 [95% CI, 0.1 to 2.6] percentage points) and among individuals with low income (difference-in-difference, 4.6 [95% CI, 0.3 to 9.0] percentage points), and in prostate cancer among individuals with low income (difference-in-difference, 3.0 [95% CI, 0.3 to 5.7] percentage points).

When compared to nonexpansion, an increase was associated with expansion in receipt of active surveillance for low-risk prostate cancer of 4.1 percentage points across all incomes. In low-income areas, this percentage increased by 4.5 percentage points.

“These findings suggest that Medicaid expansion was associated with decreases in uninsured status, increases in the proportion of kidney and prostate cancer diagnosed in an early stage, and higher rates of active surveillance in the appropriate, low-risk prostate cancer population” concluded the authors, adding “Associations were concentrated in population residing in low-income areas and reinforce the importance of improving access to care to all patients with cancer.”—Marta Rybczynski