Cancer patients have received more timely treatment since the implementation of Obamacare in the US, potentially increasing the chances of survival for African Americans and women, according to two new studies.
As Democratic presidential candidates push for more publicly funded healthcare — often dubbed Medicare-for-All — research presented at the American Society of Clinical Oncology (ASCO) showed how the Affordable Care Act 2010 improved the health of American cancer patients.
One study from Yale showed that racial disparities in how quickly patients with advanced cancer were treated disappeared in states that used the act to expand access to Medicaid, the government health insurance for low-income populations.
Another study from Johns Hopkins University found that women with notoriously hard-to-spot ovarian cancer were more likely to receive a diagnosis at an early stage after the implementation of the act, than before the legislation.
Melissa Wheeler, director of disparities and the outreach programme at the Levine Cancer Institute in North Carolina, said the studies made “perfect sense”. “It was a great thing to see for the first time thousands and thousands of people really access what they needed — to be able to go through the door of a doctor’s office,” she said.
But she warned that attempts by Congress to “peel back” parts of the act could cause a “wave of fear” that deterred patients from signing up for plans and getting treatment. “If they don’t have insurance, they won’t have a screening test — and then they turn up in the emergency department with stage-four cancer,” she said.
Expanding access to government-funded healthcare has become a key issue in the 2020 presidential election, as Democratic candidates seek to go beyond Obamacare and look at solutions such as making more — or even all — people eligible for Medicare, the public health insurance for seniors.
Having failed to completely roll back the Affordable Care Act, the Trump administration has been contesting its legality in court while trying to chip away at some of its provisions.
Richard Schilsky, chief medical officer of ASCO, said the organisation would advocate for any modification of the act to still include access to high-quality cancer care delivered by specialists and screenings. “Data presented here demonstrates the importance of good health insurance,” he said.
The Yale study showed that in the 33 states and Washington which expanded Medicaid to include more patients, there was barely any gap between the proportion of African American and white patients who received treatment within 30 days of diagnosis. This is compared with the fact that African Americans were 5 percentage points less likely to receive timely treatment in states that did not expand Medicaid.
Amy J. Davidoff, senior research scientist at the Yale School of Public Health, said many studies had described racial disparities in cancer care in the US, but few had found solutions. “National healthcare coverage policy may reduce disparities in cancer care,” she said.
In the Johns Hopkins study, the gains were modest: women diagnosed after the Affordable Care Act, from 2011 to 2014, were 1.7 per cent more likely to be in the earlier stages of the disease, than before the act.
But all gains matter because early-stage diagnosis is key: more than three-quarters of women who have the disease diagnosed at an early stage survive for at least five years, compared with 30 per cent of those in a later stage.
The early diagnosis rates also improved during the period, with about 25 per cent of women with public health insurance having their cancer caught early in 2011, and about 35 per cent by 2014.
Dr Anna Jo Smith from Johns Hopkins, lead author of the study which analysed data from the National Cancer Database, said: “These gains under the Affordable Care Act may have a long-term impact on the survival, health and wellbeing of women with ovarian cancer.”
