By Taylor Knopf

A recent Duke Cancer Institute study found that the number of uninsured cancer patients dropped by half in states that chose to expand Medicaid under the Affordable Care Act.

The expansion particularly benefited minority and low-income patients living in expansion states. North Carolina is one of 19 states that have not expanded Medicaid, which was allowed for under the ACA.

Photo of a woman in red-framed glasses looking at the camera. She's wearing a white physician's jacket.
Fumiko Chino. Image courtesy: Duke University

Lead author of the study Fumiko Chino, a fourth year radiation oncology resident at Duke University school of medicine, summed up the study saying, “Do you want more or less uninsured cancer patients? If less, then the ACA works.”

Chino’s study is in the process of being peer-reviewed, and results are not yet published. She presented her findings last month at the annual American Society for Radiation Oncology (ASTRO) meeting in San Diego.

She and her co-authors examined information from more than 197,000 records in the National Cancer Institute database of cancer patients ages 18 to 64 who received radiation treatment between 2011 and 2014.

The study includes all forms of cancer and radiation treatment. Chino said they looked at smaller groups such as breast and lung cancer patients, but did not find compelling differences in the data.

Rates of cancer patients receiving radiation who were uninsured dropped from 4.4 percent to 2.1 percent between 2011 to 2013 and the first year of the Medicaid expansion in 2014. A lot of those patients ended up on Medicaid, enrollment went up from 15.2 to 18 percent in those states.

“Rates of uninsured cancer patients in states without Medicaid expansion also declined,” the study preview reads. “But in these states, improvements appeared to primarily benefit white patients and residents of low-poverty areas, with a portion transitioning to non-Medicaid health insurance.”

Chino said she suspects that these patients were able to find individual plans in the ACA exchanges.

She and her colleagues also found Medicaid enrollment for cancer patients receiving radiation dropped in states that did not expand, going from 15.9 percent to 14.9 percent.

shows 19 states, mostly in the South, with some midwestern states, Wisconsin and Maine have not expanded Medicaid.
Current status of state Medicaid expansion decisions. Image courtesy: Kaiser Family Foundation

In ACA-compliant plans, there are essential benefits guaranteed. Chino said many cancer patients also deal with mental health issues such as depression and anxiety. She said her patients are terrified of losing coverage.

“With the increasing level of ACA sabotage that’s going on, we are chipping away at some of the gains we were making,” Chino said. “We are setting up people to buy sham insurance.”

She said the recent increase in insurance coverage will likely lead to better in mortality rates for cancer patients.

“President Trump has been honest about it. He wants the ACA to fail,” Chino said. “If it can’t happen legislatively, it’s clear they are trying to do it through executive order.”

“That’s sad for me as a cancer doctor because the ACA has helped out my patient population,” she added.

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...