Expanding Medicaid under the Affordable Care Act (ACA) is tied to lower overall mortality among women with breast cancer, according to research published January 27 in JAMA Network Open.
However, these benefits were uneven among women of various racial and ethnic and socioeconomic backgrounds, wrote a team led by Oluwasegun Akinyemi, MD, PhD, from Howard University in Washington, DC.
“These findings support Medicaid expansion as a potentially lifesaving public health policy, particularly for women with breast cancer,” Akinyemi and colleagues wrote. “However, the persistence of racial and ethnic disparities, especially among Black women, despite coverage expansion, suggests that insurance alone is insufficient and must be accompanied by targeted interventions to address structural racism, care fragmentation, and other social determinants of health.”
Medicaid expansion under the ACA was designed to improve access to care and reduce health disparities. However, the researchers noted that this expansion’s association with breast cancer mortality and related disparities is unclear.
Prior research suggests that social determinants of health worsen disparities in breast care for women. These include insurance status, income, geography, and systemic racism.
The Howard University researchers studied trends in how expanding Medicaid affects overall mortality among women with breast cancer. They also studied whether survival differs by race and ethnicity, disease stage, income, and treatment modality.
The retrospective, hospital-based cohort study used a National Cancer Database cohort of nearly 1.6 million women ages 40 to 64 with breast cancer. The women received a diagnosis from 2006 to 2021.
Of the total women, 922,862 (57.8%) lived in early-expansion states, while 672,983 (42.2%) lived in nonexpansion states. The team reported an overall lower mortality with Medicaid expansion (hazard ratio [HR], 0.95; p < 0.001), a 4.8% relative hazard reduction compared to nonexpansion.
The team also found hazard reductions for the following backgrounds: -3.4% for non-Hispanic white women, -4.3% for non-Hispanic Black women, and -19% for Hispanic women. Associations for non-Hispanic women of other race or ethnicity did not achieve statistical significance.
Finally, the researchers reported the largest gains in mortality for the following women: women with metastatic disease (-13.9%), those in the highest-income neighborhoods (-9.7%), and those receiving immunotherapy (-24.1%).
The study authors suggested that “enhanced access to screening, early diagnosis, and timely treatment, especially in low-income and racially and ethnically diverse populations,” can be attributed to survival gains observed.
The authors called for future research to study how Medicaid expansion ties into reduced mortality. These include studying adherence to guideline-recommended therapies, continuity of care, and access to high-quality oncology services.
“Longitudinal research is also needed to determine whether the survival benefits associated with expansion persist over time and whether additional policy measures can eliminate residual disparities among Black women and other historically marginalized groups,” they wrote.
Read the full study here.
