Additional Medicaid Expansion Would Provide Advantages to Patients With Melanoma

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At the 2024 American Society of Clinical Oncology annual meeting, a poster presentation demonstrated the value of Affordable Care Act Medicaid expansion for patients with melanoma. In the researchers’ assessment, expanding this coverage improved patient outcomes by facilitating early-stage diagnoses.¹

When health care coverage is extended to individuals from low-income households or communities, it can go a long way toward reducing health disparities.² These disparities largely impact people of color, Medicaid.gov reported, stating that over 25% of the uninsured adults who would qualify for expanded Medicaid are people of color. Expanding available coverage, which has not been achieved in every state, could directly impact these communities, they add. For example, prostate cancer affects Black men at a higher rate than White men. Should Medicaid coverage become more widely available, there is an increased chance for early treatment interventions and diagnosis to improve patient outcomes.

Although these data suggest the influence Medicaid expansion could have across the spectrum of health care, Win et al’s presentation titled, “The positive impact of Medicaid expansion on melanoma stage at presentation,” honed in on how this initiative could affect outcomes in melanoma.¹

The researchers utilized The National Cancer Database to identify 12,667 individuals with a new melanoma diagnosis who had Medicaid coverage. Other patients with melanoma were excluded if they had Medicare, private insurance, or an additional form of known or unknown insurance. The analysis spanned the pre-expansion period of 2010 to 2013 and the postexpansion period of 2014 to 2020. Annual trends and difference-in-difference (DID) assessments were performed to investigate tumor staging throughout states that have expanded Medicaid coverage (MES) and those that have not (non-MES).

The study population was 56% male and 95% White. Additionally, 59% of patients had Medicaid coverage between 2010 and 2020. The remaining 41% were uninsured during that time. Notable, the researchers saw uninsured rates significantly drop from 51% in 2010 to 16% by 2020.

In total, 21% of included patients were diagnosed with stage III melanoma and 18% with stage IV. In MES, the rate of stage IV melanoma at presentation fell from 21% to 17% by the end of the 10-year study period. Contrarily, in non-MES, these rates increased from 20% to 23% in the same period. After DID analysis was performed to evaluate the pre- and postexpansion periods, the researchers saw statistically significant decreases in both 3-year mortality (DID, –0.05; P < .001) and stage IV melanoma at presentation (DID, –0.04; P < .001). Furthermore, the researchers noted that immunotherapy was administered in cases of stage IV melanoma at a significantly higher rate in MES vs non-MES (47% vs 41%; P < .001).

In their conclusion, the authors emphasized the capacity for expanded Medicaid and health care services to lead to early-stage diagnosis in melanoma and reduced mortality rates. Their analysis still revealed, however, that as of 2020, 16% of patients remained uninsured. With this reality in mind, they advocated for dedicating increased efforts to providing quality care to the uninsured to improve outcomes in this population.

In 2024, an estimated 7.7% people in the US—approximately 26 million—remain uninsured.³

References

1. Win S, Amini A, Modi B, et al. The positive impact of Medicaid expansion on melanoma stage at presentation. J Clin Oncol. 2024;42(suppl 16):abstract 1533. doi:10.1200/JCO.2024.42.16_suppl.1533
2. Medicaid expansion helps address health disparities. Medicaid. Accessed June 19, 2024. https://www.medicaid.gov/about-us/program-history/medicaid-50th-anniversary/entry/47671
3. Minemyer P. CDC: uninsured rate fell by 26% between 2019 and 2023. Fierce Healthcare. June 18, 2024. Accessed June 19, 2024. https://www.fiercehealthcare.com/payers/cdc-uninsured-rate-fell-26-between-2019-and-2023#:~:text=The%20study%20projects%20that%20the,are%20uninsured%20as%20of%202024

[This article was originally published by our sister publication, American Journal of Managed Care.]