South Central Section of the AUA 2022

SCS AUA 2022: The Impact Of Medicaid Expansion On Insurance Status, Clinical Presentation, And Timely Treatment Of Hispanic Patients With Bladder, Kidney, And Prostate Cancers

( The impact of the Patient Protection and Affordable Care Act’s Medicaid expansion (ACA) on cancer care is understudied. The objective of this study was to assess the impact of ACA implementation on insurance status, stage at diagnosis, and timely treatment among patients with bladder, kidney, and prostate cancer among racial/ethnic groups.

The National Cancer Database was queried for patients with a new primary diagnosis of bladder, kidney, or prostate cancer between 2011–2016 (aged 40-65 years). Difference-in-differences (DID) regression analyses were performed comparing patients residing in Medicaid expansion vs. non-expansion states before and after ACA implementation with January 1st, 2014 used as a cut-off. Outcomes investigated included changes in insurance status, cancer stage at presentation, and timely treatment within 30 and 90-day of diagnosis. Subgroup analyses were performed to evaluate the impact of ACA on different race/ethnic groups (Non-Hispanic White [NHW], Non-Hispanic Black [NHB], and Hispanic).

A total of 734,776 patients (mean age 57.7+/-5.7 years); 75.2%NHW, 16.1%NHB, and 5.5%Hispanic) had a new diagnosis of bladder (12.9%), kidney (24.8%), and prostate (62.3%) cancer. 62.6% of the patients resided in expansion states. Hispanics had the highest uninsured rates compared to NHWand NHB in both expansion and non-expansion states (8.92% and 19.2% vs. 2.7% and 4.4% vs. 5.8% and8.7%, respectively). The uninsured rates for Hispanics decreased from 8.92% to 4.36% after expansion in expansion states. Contrary to NHW and NHB, this decrease wasn’t significantly different between expansion and non-expansion states. (DID −1.07, 95%CI -2.28to0.13 PP, p<0.08).Among Hispanics residing in expansion states, there was an observed increase in the diagnosis of Stage-I disease after expansion (DID:2.74, 95%CI 0.88to4.6 PP, p=0.004) and increase in the percentage treated within 30 days (DID:2.27, 95%CI 0.14to4.41 PP, p=0.037). Such impact was not observed in NHW and NHB.

This study found that, among patients with bladder, kidney, and prostate cancer, Hispanic patients had the highest uninsurance rates compared to NHW and NHB before and after Medicaid expansion. Among racial/ethnic groups, Hispanics experienced a greater increase in coverage followed byNHB and NHW. The impact of Medicaid expansion on early-stage cancer diagnosis and timely treatment was more evident in the Hispanic population. These findings suggest that further reforms that result in improving healthcare coverage can mitigate disparities for racial/ethnic minorities. Given the mid-term elections underway, these findings have important health policy implications targeting at-risk populations as we consider universal health care options along with value-based payment models.

Presented by: Levi A. Hamilton, MD, BS, University of Texas Health San Antonio, Department of Urology, San Antonio, TX

Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological Association Annual Meeting, September 6-10, 2022, Coronado, CA