Study: Medicaid expansion boosted colon cancer screening, survival in Kentucky

Following Kentucky’s Medicaid expansion under the Affordable Care Act, colon cancer screening jumped 230 percent in the state, according to a Feb. 22 study performed by the University of Kentucky in Lexington. Adoption also led to a 27 percent decrease in mortality risk.

In the study, Avinash S. Bhakta, MD, and colleagues at the university included more than 930,000 individuals screened for colorectal cancer (CRC) from the Kentucky Hospital Discharge Database in the Kentucky Cabinet for Health and Family Services and the state’s Cancer Registry. Prior to ACA-expansion (2011-13) about 14 percent of residents were uninsured, which dropped to 6 percent after expansion (2014-16).

Statewide, the number of Medicaid patients who received screening jumped 230 percent after the state expanded Medicaid, with a 27 percent decrease in the risk of death due to CRC. Additionally, more than 11,000 new CRCs were diagnosed from 2011 to 2016, raising the incidence of such cancers by. 6.7 percent in those covered by Medicaid.

Nowhere was expansion felt more than in the Appalachian area of the state in which 43 percent more patients received screening. While there was little change in early stage—defined as stage I or II—detection of CRCs across Kentucky, that proportion increased by 9.3 percent for the Appalachians—the state’s most vulnerable residents.

That region, encompassing the eastern half of Kentucky, had a higher incidence rate (55.1 cases per 100,000) and mortality rate (20.2 deaths per 100,000) compared to the entire state’s rates of 50 cases per 100,000 and 17.2 deaths per 100,000.

"Colorectal cancer is treatable, and it's also preventable through appropriate screening," said Bhakta, colorectal surgeon at the UK Markey Cancer Center, in a news release. "The takeaway here is that screening does matter, and the expansion of Medicaid has increased usage of colon cancer screening for many Kentuckians who otherwise wouldn't have had access."

Bhakta and colleagues wrote their study confirmed the importance of insurance coverage in bolstering CRC screening. In the Appalachian region the poverty rate is 1.7 times the national average, with a lack of insurance a primary factor in not seeking CRC along with a lack of provider recommendation, the authors wrote. In the second year of ACA Medicaid expansion the researchers noted a 12 percent jump in access to primary care physicians which provided physician access to more than 85 percent of low-income patients.

“Affordable Care Act Medicaid expansion has positively affected insurance coverage in this population, leading to improved CRC screening and improved short-term survival,” the researchers concluded. “Future long-term survival studies are needed, but the short-term benefits of the ACA expansion have bridged a gap in CRC disparities in Kentucky.”

The full study results were published online Feb. 22 in the Journal of the American College of Surgeons.