A Rising Tide Raises All Ships: Was the Effect of Medicaid Expansion on Cancer Outcomes Similar Across Subgroups of Patients With Cancer on Medicaid?

Introduction: The authors determined whether certain subgroups of patients with cancer on Ohio Medicaid benefited from the program's expansion to a greater/lesser extent. Study outcomes included stage at diagnosis for screening-amenable cancers (breast [n=1,707 and 2,976], cervical [n=309 and 655], and colorectal [n=927 and 2,009] cancer, before and after expansion, respectively) and time to treatment initiation. Methods: Using linked data from the 2011–2017 Ohio cancer registry and Medicaid, the authors conducted a robust Poisson regression analysis for stage at diagnosis and Cox regression analysis for time to treatment initiation to obtain the adjusted risk for earlier stage at diagnosis before to after expansion or hazard of shorter time to treatment initiation for each demographic or clinical subgroup after compared with before pre-Medicaid expansion. The authors subsequently calculated the ratio of risk (or hazard) ratios. Results: The effect of Medicaid expansion on outcomes was mostly similar across subgroups of patients with cancer on Medicaid. However, those who were non-Hispanic Black or of other race had a lower probability of being diagnosed with early-stage breast cancer (ratio of risk ratio=0.85 [95% CI=0.74, 0.98] and ratio of risk ratio=0.72 [95% CI=0.55, 0.95], respectively) than non-Hispanic White women. Conclusions: These findings point to differences that should be investigated to ensure that the benefits of Medicaid expansion are realized equitably.