Massachusetts Health Insurance Reform, Model for ACA, Seen to Improve Colon Cancer Care

Massachusetts Health Insurance Reform, Model for ACA, Seen to Improve Colon Cancer Care

A 2006 Massachusetts health care reform, which served as model for the Affordable Care Act (ACA), was associated with higher surgery rates and a lower probability of emergency surgeries for colorectal cancer, according to a recent study conducted at the Massachusetts General Hospital in Boston.

The study, “Impact of Health Insurance Expansion on the Treatment of Colorectal Cancer,” published in the Journal of Clinical Oncology, suggests that health insurance expansion under ACA reforms may improve access to care for people with colorectal cancer, the third most common cancer in the U.S.

“Lack of insurance and other socioeconomic factors have been associated with lower rates of screening for colorectal cancer,” Andrew P. Loehrer, MD, MPH, medical director of the Codman Center for Clinical Effectiveness in Surgery at Massachusetts General Hospital, and colleagues wrote. “Such social determinants are also associated with more advanced-stage cancer at time of diagnosis, greater likelihood of undergoing emergent resection and lower survival relative to privately insured patients.”

Massachusetts’ health reform, the researchers said, is a unique experiment with which to assess the impact of expanding insurance on access and treatment for colorectal cancer.

Among the measures it implemented: the expansion of Medicaid coverage for those living below 150 percent of the federal limit of poverty; the creation of a state-subsidized insurance program (called Commonwealth Care) for people whose income was less than 300 percent of the federal poverty limit, but who remained ineligible for Medicaid; and a mandate requiring state residents to have health insurance. Statewide, the uninsured rate subsequently fell to below 5 percent.

To examine the effects of the law, Loehrer and colleagues looked at overall trends in colorectal cancer before and after the 2006 reform. Hospital Cost and Utilization Project State Inpatient Databases were used to identify patients with colorectal cancer with government-subsidized insurance, private insurance, or self-pay who were admitted to a hospital between 2001 and 2011 in Massachusetts (17,499 patients), or to hospitals in New York, New Jersey, and Florida (144,253 patients) that served as controls for comparison.

Researchers found that before the reform, colorectal cancer patients on subsidized insurance or paying out-of-pocket  were significantly less likely to have surgery than those with private insurance in either Massachusetts or the other three states.

After health insurance was extended to all state residents, admissions for colorectal cancer surgeries rose by 15 percent among government subsidized and self-pay patients in Massachusetts, a rate of increase that was 44 percent higher than was seen in the control states.

Likewise, researchers estimated that the reform brought about a 6.21 percent decreased probability of emergency admission for these cancer patients, and a 8.13 percent increased likelihood of an elective surgery.

While disparities had decreased with regard to cancer surgeries for government-subsidized or self-pay patients, the researchers said significant gaps remained.

“A gap in resection rates and emergent admissions at the time of surgery persists by payer status,” Loehrer and colleagues wrote.

Still, expanded insurance coverage helped to improve access to care for colorectal cancer patients, especially among those most disadvantaged.

“Overall, the Massachusetts experience provides cautiously optimistic evidence that expanded insurance coverage may help facilitate more equitable access to and receipt of cancer care,” they wrote.

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