Medicaid expansion reduce cancer, saves black lives

January 29, 2020

Expanding Medicaid in North Carolina could sharply lessen the burden of colon cancers in the state and save the lives of thousands of Black men as well as improving access to care for men of all races, researchers report in the 27 January issue of PLOS ONE.

Cancers of the colon and rectum kill tens of thousands of people in the US each year and are particularly common among African American men. For every hundred thousand residents of the US in 2016, 37 cases of colorectal cancer were reported, and 14 deaths. For Black men, the numbers were higher: 49 cases per hundred thousand. And the rates of colon and rectal cancers are higher in Appalachia and the South compared to other parts of the country.

North Carolina, a southern state that extends into Appalachia, declined to expand access to Medicaid as part of the Affordable Care Act. That law, also known as Obamacare, not only required states to set up health insurance exchanges but also gave states the opportunity to use federal money to extend Medicaid to anyone with income up to 138% of the federal poverty level. Previously, Medicaid primarily covered poor women and children. Expanded Medicaid also covered men of working age, if their income was below the threshold.

Researchers at UConn Health and University of North Carolina (UNC) saw an opportunity to use North Carolina as a natural experiment to test whether the expansion of Medicaid could have actually reduced illness--and whether it would have saved money for the state in the long term.

"If we had expanded Medicaid in North Carolina, could we have saved lives?" That was the question Wizdom Powell, director of the UConn Health Disparities Institute, wanted to answer. Powell, UNC systems scientist Leah Frerichs, and their colleagues at UNC created a population model that simulated all the African American and white men in North Carolina, based on county by county demographics. Every individual in the model (more than 338,000 Black men and 1,496,000 whites) was assigned a probability of colon cancer screening, based on real world statistics related to income, race and neighborhood data.

They then ran the model under several different scenarios. One, in which North Carolina set up a health insurance exchange but did not expand Medicaid, mimicked what actually happened. And the rates of sickness and death caused by colon cancer in that scenario match what has actually happened in North Carolina in recent years, giving the researchers confidence the model is accurate.

Other scenarios looked at what would have happened if North Carolina had both expanded Medicaid and set up a health insurance exchange.

"And we saw that if we had done that, we would have saved hundreds of Black male lives--and increased cancer screening among both Black and white men," Powell says.

"It was enlightening to see the impact on disparities," Frerichs says. And she points out how much the state would gain, for little cost. Initially, by expanding Medicaid the state of North Carolina would pay a couple dollars more for every African American man in 2018, but it would save $5.1 million in cumulative cost savings by 2044. And the state would save $9.6 million in cumulative savings for white males.

The researchers are expanding the model to encompass all adults of all races in the state, and are looking at other questions, such as the effects of proposals like Medicare for all.

University of Connecticut

Related Colorectal Cancer Articles from Brightsurf:

Colorectal cancer treatment: the winning combinations
Chemotherapy has distressing side effects for patients and increases the risk of developing resistance to the treatment.

A new model to predict survival in colorectal cancer
This signature could be useful in clinical practice, especially for colorectal cancer diagnosis and therapy.

Roadmap to reducing colorectal cancer deaths
The American Gastroenterological Association has outlined a strategy to increase the number of people screened via tests that are more convenient, accurate and less expensive and tailored to people's individual cancer risks.

Study provides new insight on colorectal cancer growth
A new study by researchers at the University of Kentucky identifies a novel function of the enzyme spermine synthase to facilitate colorectal cancer growth.

Researchers ID target for colorectal cancer immunotherapy
Researchers at the Indiana University Melvin and Bren Simon Comprehensive Cancer Center have identified a target for colorectal cancer immunotherapy.

Colorectal cancer partner-in-crime identified
A protein that helps colorectal cancer cells spread to other parts of the body could be an effective treatment target.

Cancer cell reversion may offer a new approach to colorectal cancer treatment
A novel approach to reverse the progression of healthy cells to malignant ones may offer a more effective way to eradicate colorectal cancer cells with far fewer side effects, according to a KAIST research team based in South Korea.

A novel pathway to target colorectal cancer
Survival rates for patients with late-stage colorectal cancer are dismal, and new therapeutic strategies are needed to improve outcomes.

Colorectal cancer rates in Canada
The incidence of colorectal cancer among younger adults increased in recent years in this analysis of data from Canadian national cancer registries that included about 688,000 new colorectal cancers diagnosed over more than 40 years.

Cancer drugs promote stem cell properties of colorectal cancer
Scientists from the German Cancer Research Center (Deutsches Krebsforschungszentrum, DKFZ) and the Mannheim University Medical Center have now discovered that a certain group of cancer drugs (MEK Inhibitors) activates the cancer-promoting Wnt signalling pathway in colorectal cancer cells.

Read More: Colorectal Cancer News and Colorectal Cancer Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to