• A new study shows that expanding Medicaid coverage led to increased rates of earlier cancer detection for people with low incomes.
• Oklahoma recently became the latest state to vote to increase Medicaid access, another example that many American voters want this service to be more available, even as it remains a hotly debated topic.
• Experts say the health crisis posed by COVID-19 only further emphasizes the importance of fixing some systemic problems in the United States healthcare system, like access to insurance.

Expanding Medicaid to more Americans has become an issue that straddles political debates as much as it does healthcare concerns. As more states pursue making Medicaid increasingly more accessible, how might that impact health outcomes, especially among some of the most vulnerable populations in the United States?

New research out of Case Western Reserve University reveals that expansion of Medicaid has resulted in earlier detection rates for cancer, specifically, among people with low incomes.

Experts say this is an indication of how health outcomes could be vastly improved especially among people in lower income brackets if Medicaid was more widely available.

The new study was published in Cancer, a journal from the American Cancer Society. The researchers looked at data from 12,760 people in Ohio between 30 and 64 years old who were diagnosed with colorectal, cervical, breast, or lung cancer. The diagnoses ranged from 2011 through 2016, and the individuals studied either had Medicaid at the time or were completely uninsured.

They then compared the individuals who received their diagnoses from 2011 to 2013 — or, before Medicaid expansions — with those from 2014 to 2016, the time after Medicaid expansions. The researchers also looked at whether the people in the study group were diagnosed with early or advanced cancer.

The results? People with lower incomes who received diagnoses in the later period — post-Medicaid expansion — had 15 percent lower odds of having metastatic, or advanced, cancer compared with those in the earlier period. The research team used data on people with higher incomes who had private insurance as a control group.

“I guess that the most surprising thing about the results was just the magnitude of the effect Medicaid expansion had — 15 percent is a big effect to happen over 3 years in a vulnerable group,” said senior author Dr. Johnie Rose, assistant professor at the Center for Community Health Integration and director of the Preventive Medicine Residency Program at Case Western Reserve University School of Medicine.

Rose told Healthline that it was notable how the noticeable gap of health outcomes among rich and poor that has always persisted in the United States seemed to lessen so clearly in such a short amount of time with Medicaid expansion.

A history of Medicaid expansion

For context, the Affordable Care Act, or “Obamacare,” increased Medicaid coverage for U.S. adults with incomes up to 138 percent of the federal poverty level. Individual states started to adopt their Medicaid expansions in 2014, increasing enrollment among many people who had been uninsured in the past, according to a press release for the study.

Medicaid is a term that is often confused with Medicare. While Medicare is designed to provide medical insurance coverage to people 65 and older, Medicaid is a policy that aims to offer coverage to people and families with low incomes.

Offering this government service to more people has been a hot-button political issue in recent years. Recently, Oklahoma surprised some healthcare policy experts and political pundits when its residents voted to expand Medicaid coverage through a ballot initiative, CNN reports.

While the measure barely squeaked by with a majority vote of 50.5 percent, Oklahoma is now one of 38 states that have expanded Medicaid, according to the Kaiser Family Foundation.

Leighton Ku, PhD, MPH, professor and director of the Center for Health Policy Research at the Milken Institute School of Public Health at George Washington University, told Healthline that Oklahoma’s decision is an example where voters went against the objections of their Republican governor and legislators and said Medicaid is “an important service.”

He added that this is especially true now during concerns over COVID-19 and its impact on people who remain uninsured in this country.

“The majority of Oklahomans who voted say, ‘We think you’re going in the wrong direction, expand eligibility for people,'” said Ku, who is not affiliated with the new study. “It will be interesting to see how the state responds. I will say some of these states like Oklahoma and Missouri have exceptionally high cancer rates; part of this is the difficulty people have in earlier access to care and detection”

‘Real systemic issues’

Rose added that when it comes to a lot of cancers, for instance, people with lower incomes who don’t have insurance of any kind are automatically put at a disadvantage. If a patient doesn’t have a relationship with a doctor who notices the “alarm bells” for early signs of cancer or their only medical interactions are those had in emergency rooms, a danger arises where cancers are caught too late.

“I just think that access to care really matters and what we were able to show is the really meaningful change in a health outcome that can come from access to care,” Rose added. “If more people have insurance, the more likely they will go to the doctor, the more people will get screened.”

Ku echoed those thoughts. He stressed how key it is to have access to a primary care physician. It doesn’t just solely involve cancer. A host of other chronic, serious conditions can be detected, treated, and prevented by regular access to a doctor’s office.

Medicaid expansion also makes things easier for physicians. Ku said that a doctor won’t feel the pressure to not see a patient if there is a concern that person can’t afford to get a needed test, for instance.

“We do know that earlier detection leads to better outcomes,” Ku said. “In this specific time of COVID-19, lots of people are delaying some of those early care appointments, they’re worried about going to the doctor, out of fears of risking infection, but also paying for medical care. Medicaid helps overcome that bump.”

Rose said this era offers a devastating “natural experiment.” While a pandemic rages, countless people with lower incomes remain uninsured in the United States.

“We are unfortunately going to be able to compare how newly jobless American workers fare not just in cancer but in other health outcomes in states that expanded Medicaid and those that didn’t,” he explained. “In so many situations when there is a crisis, the folks who bear the brunt are the folks with the fewest resources — they’re starting off somewhat behind.”

Rose said the findings of this research offers something of a wakeup call to Americans.

“We are, never as a country, going to catch up with other countries in terms of our health outcomes as long as there are significant parts of the population that have significantly worse outcomes,” he added.

“I don’t think people realize how poor our health outcomes are here and how poorly parts of our health system perform compared to the rest of the world,” Rose stressed. “I think that’s lost on people. Our health system can do some wonderful things, train some wonderful doctors, but we have some real systemic issues.”

The bottom line

A new study shows that expanding Medicaid coverage led to increased rates of earlier cancer detection for people with low incomes.

Oklahoma recently became the latest state to vote to increase Medicaid access, another example that many American voters want this service to be more available, even as it remains a hotly debated topic.

Experts say the health crisis posed by COVID-19 only further emphasizes the importance of fixing some systemic problems in the United States healthcare system, like access to insurance.

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