e19003 Background: For socioeconomically disadvantaged individuals without insurance, expenses related to diagnosis and management of chronic conditions, such as cancer, may be too costly to afford. This contributes to diagnoses made at later stages of disease, and inadequate treatment compliance. These factors are reported to lead to unfavorable clinical outcomes and higher mortality risk, historically making uninsured/Medicaid-ineligible patients an especially vulnerable group. With recent Affordable Care Act-related Medicaid expansion, state adoption allows new access to coverage for individuals with income <138% of the federal poverty limit. Therefore, we sought to understand how Medicaid expansion has affected demographic coverage and access to care among socioeconomically disadvantaged breast cancer patients. Methods: The data presented herein was extrapolated from a 2004-2016 NCDB breast cancer population. Sociodemographic and clinical data was evaluated for a sample of Medicaid-enrolled patients, diagnosed during pre- and post-expansion years. Results: In Medicaid-expanded states, there was a significantly increased utilization of Medicaid insurance (24.3% vs. 13.2%; p<0.001), and a significant trend towards an increased proportion of Hispanic enrollment in Medicaid (21.1% vs. 11.8%; p<0.001) than in non-expanded states. In non-expanded states, there was a larger proportion of black patients (p<0.001), and patients who live further from diagnostic centers (p<0.001), in more rural areas (p<0.001), with lower education levels (p<0.001). The total study population of Medicaid-enrolled patients was n=42,217; the total comparative uninsured population was n=13,133. Medicaid-enrolled patients were observed to have more timeliness to systemic treatment following diagnosis (85.6 vs. 87.6 days; p=0.021), and were 40% less likely to be diagnosed with late-stage disease (p<0.001) than uninsured patients. Conclusions: Medicaid expansion may be associated with a less diagnosis at late stages, more timeliness to treatment, and more Hispanic coverage, which may prove to be a positive paradigm shift in cancer outcomes for underserved and underinsured groups. Several socioeconomic factors already identified as being independently associated with poor outcomes are more prevalent in the non-expanded state populations compared to the expanded states. Therefore, while benefits have been noted in patients of expanded states, many breast cancer populations still remain vulnerable in the post-expansion era.
ASO Author Reflections: Medicaid Expansion is Key in Mitigating Surgical Disparities in Low-Income Breast Cancer Patients
