Cancer patients in the US argue that limited use of Medicaid with higher income thresholds was more likely to die than those living in states with lower limits, medical records show.
States began allowing more of the country’s poor to enroll in Medicaid under the Affordable Care Act, which subsidizes much of the excess costs with federal dollars. While most states have passed the ACA standard for eligibility – that’s a family or personal income of 138% of the federal poverty level – 14 states have not, with some demanding financial difficulties in granting access.
Findings from a survey of 1.4 million people diagnosed with cancer between 2010 and 2013 illustrate the implications. For example, patients with early-stage breast cancer were 31% more likely to die during eight years of follow-up in low-access states, according to a report released Wednesday ahead of the meeting of the American Society of Clinical Oncology June 4. -8.
“Many studies have shown that the expansion of Medicaid under the ACA is linked to better health insurance coverage, earlier screening, earlier diagnosis and a reduction in the unaffordability of care,” said Robin Yabroff, scientific vice president of health services research. for the American Cancer Society and a co-author. “Studies are just beginning to look at the effect on survival.”
Medicaid provides health coverage to eligible adults and low-income children. While there are some federal requirements, states manage the plans and have significant discretion in determining the income threshold for eligibility.
According to the ACA, signed into law on March 23, 2010, the federal government pays about 90% of the costs for the expansion population. The law, often referred to as Obamacare, has been under fire from Republicans since its adoption.
The research data comes from a time when there was even more spectrum to qualify for the state. About one-fifth of the patients followed lived in states where the income line was 50% of the federal poverty line, about a third met the expanded ACA standard, and the rest of the patients were in states where eligibility was somewhere in between.
Overall, survival rates for 17 common cancers were found to be worse for patients in low-income states and best for those in high-eligibility states, said Jingxuan Zhao, a senior assistant scientist at the cancer company who led the study.
The 12 states that have not passed comprehensive Medicaid rules include Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming. Oklahoma and Missouri, meanwhile, have adopted the ACA standard, but have not implemented it.
A health attorney filed paperwork earlier this year for a voting initiative to take over Medicaid expansion in Mississippi, but suspended it after the state’s Supreme Court blocked new measures against the vote in 2022. The group, the Fairness Project, has said it is still pursuing a similar initiative in South Dakota.
States with the lowest eligibility are demanding financial woes to enable access to Medicaid, Yabroff said. For example, to be eligible for the program in Georgia, adults must earn no more than one-third of the federal poverty level – about $ 13,000 for individuals and $ 22,500 for a family of three.
In these restrictive states, “individual adults are rarely eligible, regardless of income,” she said.