Medicaid, the ACA, and Breast Cancer Survival

Healthcare as a human right has been championed by many for generations, yet significant inequities still exist among vulnerable populations in the U.S. Disparities in accessing care or receiving optimal care have been documented in cardiovascular health, cancer care, and diabetes management, as examples. Suboptimal healthcare outcomes, including overall survival (OS), are experienced more often in certain racial, ethnic, and socioeconomic groups.

These investigators assessed whether mortality disparities improved for patients with de novo metastatic breast cancer in states that expanded Medicaid coverage under the Affordable Care Act (ACA). Using data from the National Cancer Database, they evaluated survival outcomes in 19 states before and after expansion, comparing white and other racial/ethnic populations.

The analysis included 5077 patients aged 40 to 64 with a diagnosis in the 4-year preexpansion period and 4245 in the 3-year postexpansion period. The white group comprised 6777 patients (73%) and the other racial/ethnic group comprised 2545 (27.3%) patients, including 5.4% Hispanic (any race), 16.3% non-Hispanic Black, and 5.7% non-Hispanic other (American Indian or Alaska Native, Asian or Pacific Islander, unknown).

Overall survival was significantly higher among white patients than those of other racial/ethnic identities in the preexpansion period (64% vs. 56%) but did not differ significantly between groups in the postexpansion period (71.0% and 71.8%). Overall, 2-year mortality declined from 32.2% preexpansion to 26.0% postexpansion. The adjusted 2-year mortality decreased from 40.6% to 36.3% among white patients and from 45.6% to 35.8% among other racial/ethnic groups. Among patients in the lowest income quartile, other racial/ethnic groups had an increased risk of death compared with white patients in the preexpansion period but lower risk in the postexpansion period.