Disparities in Time to Treatment Erased in the Affordable Care Act Era

In states that opted to expand Medicaid under the Affordable Care Act (ACA), the time to receiving cancer treatment was nearly identical among white and black patients, but remained constant among patients in states without Medicaid expansion, according to a new study from the Yale School of Public Health.

The information was presented as a plenary abstract at the American Society of Clinical Oncology’s (ASCO’s) 2019 Annual Meeting in Chicago by study co-author Amy Davidoff, PhD.

In the study, Dr. Davidoff and colleagues analyzed data from 18,678 patients who were treated for cancer before states expanded Medicaid access or in states that chose not to expand Medicaid, then compared them with data from 11,708 patients who were treated in states that opted for Medicaid expansion.

They observed a substantial racial disparity in time to cancer care without Medicaid expansion: 48.3% of white patients received chemotherapy within a month of their diagnosis, compared with 43.5% of black patients – representing a 4.8 percentage point difference (p<0.001).

However, in states with Medicaid expansion, this difference decreased to 0.7 points (50.3% for white patients vs. 49.6% for black patients; p=0.63).

Though the research suggests that Medicaid expansion led to improved health equity, Dr. Davidoff noted that the study did not analyze time to treatment according to patients’ economic status and was not able to determine which patients actually received Medicaid.

“If you can’t access care you can’t benefit from care,” commented Richard L. Schilsky, MD, ASCO’s chief medical officer. “For all the advances we’ve observed in recent years in cancer treatment, in cancer care broadly speaking, if you don’t have insurance, if you can’t access care, if you can’t get care in a timely fashion, you can’t benefit.”

Sources: STAT, June 2, 2019; Adamson BJS, Cohen AB, Estevez M, et al. Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment. Abstract LBA1. Presented at the 2019 ASCO Annual Meeting; June 2, 2019; Chicago, IL.