The Impact of Medicaid Expansion on Breast and Cervical Cancer Screening Rates

The Impact of Medicaid Expansion on Breast and Cervical Cancer Screening Rates
Author: Madelyn Jane Sather
Publisher:
Total Pages: 40
Release: 2021
Genre:
ISBN:

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Screenings are an important public health intervention to prevent breast and cervical cancer. Previous studies have indicated a relationship between Medicaid expansion under the Affordable Care Act (ACA) and breast and cervical cancer screenings, but the results have been mixed and inconclusive. We examined the relationship between Medicaid expansion and breast and cervical cancer screenings among low-income women. In our secondary analyses, we assessed if this association was modified by race/ethnicity or rural residence status. We used data from the Behavioral Risk Factor Surveillance System from 2012-2019, excluding 2017. States that expanded Medicaid before the ACA were excluded. A total of 27 states were considered Medicaid expansion states and 17 were considered non-expansion states. Participants included women with incomes up to 138% of the Federal Poverty Level (FPL) without a previous cancer diagnosis, excluding Medicare-eligible ages. Using a difference-in-difference time series event design, this study compared the odds ratio of breast and cervical cancer screenings for a total of 8 years pre- and post-Medicaid expansion controlling for age, race/ethnicity, education, income, employment, having a regular healthcare provider, rurality, and year and state fixed effects. Dummy variables on years from expansion were created from 7 years before expansion up to 5 years after expansion, including a dummy variable indicating the expansion year. The expansion year dummy variable was coded as 1 if the year of observation was equivalent to the year when the state expanded Medicaid and 0 otherwise. Stratified analyses were used to test if there was an interaction at the multiplicative level by race/ethnicity or rurality. Among 27,290 women aged 40-64, 76.4% of the women residing in expansion states reported having an up-to-date breast cancer screening compared to 70.8% of women residing in non-expansion states. Among 30,808 women aged 18-64, 82.3% of the women residing in expansion states reported having an up-to-date cervical cancer screening compared to 79.9% of women residing in non-expansion states. Medicaid expansion was associated with 2.89-fold higher rate of up-to-date breast cancer screenings 1 year post-expansion (aOR 2.89; 95% CI: 1.34, 6.23). The odds ratios relating Medicaid expansion and up-to-date cervical cancer screenings during the expansion year and 4 years post-expansion were 1.35 (95% CI: 1.14, 1.61) and 1.37 (95% CI: 1.01, 1.85), respectively. The associations were stronger among White non-Hispanic, Black non-Hispanic women, and urban women for both breast and cervical cancer screenings. Medicaid expansion led to higher rates of up-to-date breast and cervical cancer screenings during some years pre- and post-expansion. These associations were modified by race/ethnicity and rurality. Future research should control for baseline rates of up-to-date breast and cervical cancer screening rates. A longitudinal study should be conducted to further control for time-varying confounders. Findings support adoption of Medicaid expansion should be adopted by all states to improve breast and cervical cancer screening rates for low-income women.

The Affordable Care Act’s Dependent Mandate and Medicaid Expansion

The Affordable Care Act’s Dependent Mandate and Medicaid Expansion
Author: Marisela R. M. Moran
Publisher:
Total Pages: 33
Release: 2021
Genre:
ISBN:

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Cervical cancer screenings increased following passaging of the Affordable Care Act (ACA) of 2010. The ACA's goals were to expand comprehensive women's health screenings, expand coverage for young adults up to age 26 through the Dependent Coverage Mandate, and provide coverage for low socio-economic citizens by expanding Medicaid. This paper is a qualitative analysis of archival data from peer-reviewed journal articles about the enactment of the Affordable Care Act and how it has affected cervical cancer screenings for young adults' pre-ACA and post-ACA. In this paper, a comparative analysis was assessed for states that enacted the Medicaid Expansion versus those that did not, and the effect on racial/ethnic, low socioeconomic, and educated female populations. Peer-reviewed journals were reviewed and analyzed from the California State University, Northridge Library database. The keywords used when searching the database and 2,434 articles were initially retrieved, and 1,783 were excluded. These were limited done to those published between 2010 and 2020, with cervical cancer screening in the United States being the keywords most identified. Articles were assessed that addressed the changes to cervical cancer screenings pre-ACA and post-ACA for young adults, Medicaid, and social disparities. These studies were compared using a difference-in-difference methodology. The Affordable Care Act was a legislative process for the newly elected President Barrack Obama and his Democratic Congress in 2008. Both Republicans and Democrats have proposed healthcare reform going all the way back to World War II when unions advocated for their workers. It remained a debated topic in to the 2000s as to whom would mandate and provide healthcare coverage, the federal government, or the states. This analysis examines, through Kingdon's Model, the need and process of reform that enabled the Affordable Care Act to pass. Following the enactment of the ACA, one in five young adult women were uninsured, whereas prior to the ACA one in three were uninsured. There was an increase in screening for young adults following the ACA from 2009 to 2011 (67.9% vs 84.3%), however there has been a recent decline in screening, while there has been an increase in HPV vaccines, the only known vaccine that prevents Cervical cancer. For states that enacted the Medicaid expansion, Medicaid visits increased from 33.8% in 203 to 52.7% in 2015. Analysis was conducted for socioeconomic and racial disparities, and it showed the same positive statistic for an increase in screening. For non-Hispanic Blacks in expansion states their screening rates went from 43.5% pre-ACA to 51.2% post-ACA. Though cervical cancer screenings increased following the enactment of the ACA, there remains barriers to compliance for women to be screened for this preventable cancer. Not all 50 states have expanded Medicaid, leaving low socio-economic and ethnic groups at a disadvantage to seeking low-cost screenings that Medicaid would cover. Health literacy remains a large barrier to inform adults about the need for routine cervical cancer screenings, as they write most medical information at a higher reading level. With more young adults receiving the HPV vaccine, the American Cancer Society is investigating if it is a more worthwhile endeavor to test for HPV and replace the cervical Pap Smear test with HPV testing only. The ACA's goal of screening more women was achieved, however there still is the Healthy People goal of screening 84.3% of the US female population by 2030. More research would need to be conducted to examine hesitancy for screening rates 10 years following the ACA and how to reach subgroups of young adults and underserved populations.

Medicaid

Medicaid
Author: James C. Cosgrove
Publisher: DIANE Publishing
Total Pages: 44
Release: 2009-12
Genre: Health & Fitness
ISBN: 1437918301

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Tens of thousands of women die each year from breast or cervical cancer. While screening and early detection -- followed by treatment -- can improve survival, low-income, uninsured women are often not screened. In 1990, Congress authorized the CDC to fund screening and diagnostic services for such women. An Act signed into law in 2000 allowed states to extend Medicaid eligibility to women screened under the Early Detection Program (EDP) and who need breast or cervical cancer treatment. This report examined the EDP's screening of eligible women, states' implementation of the Treatment Act, Medicaid enrollment and spending under the Treatment Act, and alternatives available to women ineligible for Medicaid under the Treatment Act. Illus.

Fulfilling the Potential of Cancer Prevention and Early Detection

Fulfilling the Potential of Cancer Prevention and Early Detection
Author: National Research Council
Publisher: National Academies Press
Total Pages: 564
Release: 2003-05-07
Genre: Medical
ISBN: 0309170133

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Cancer ranks second only to heart disease as a leading cause of death in the United States, making it a tremendous burden in years of life lost, patient suffering, and economic costs. Fulfilling the Potential for Cancer Prevention and Early Detection reviews the proof that we can dramatically reduce cancer rates. The National Cancer Policy Board, part of the Institute of Medicine, outlines a national strategy to realize the promise of cancer prevention and early detection, including specific and wide-ranging recommendations. Offering a wealth of information and directly addressing major controversies, the book includes: A detailed look at how significantly cancer could be reduced through lifestyle changes, evaluating approaches used to alter eating, smoking, and exercise habits. An analysis of the intuitive notion that screening for cancer leads to improved health outcomes, including a discussion of screening methods, potential risks, and current recommendations. An examination of cancer prevention and control opportunities in primary health care delivery settings, including a review of interventions aimed at improving provider performance. Reviews of professional education and training programs, research trends and opportunities, and federal programs that support cancer prevention and early detection. This in-depth volume will be of interest to policy analysts, cancer and public health specialists, health care administrators and providers, researchers, insurers, medical journalists, and patient advocates.

Medicaid

Medicaid
Author: United States Government Accountability Office
Publisher: Createspace Independent Publishing Platform
Total Pages: 44
Release: 2018-01-21
Genre:
ISBN: 9781984058867

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Medicaid: Source of Screening Affects Women's Eligibility for Coverage of Breast and Cervical Cancer Treatment in Some States

Access Standards for Covered Services Within the Pennsylvania Medicaid Program

Access Standards for Covered Services Within the Pennsylvania Medicaid Program
Author: Kelly Abraham
Publisher:
Total Pages: 35
Release: 2010
Genre:
ISBN:

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Background: Breast cancer is the most common cancer in women aside from non melanoma skin cancer (CDC, 2009a) All women are at risk for cervical cancer, but the disease usually occurs in women 30 years and older (CDC, 2010a). Access standards for breast and cervical cancer screenings in the Medicaid program appear to be limited. The study hopes to address standards that define adequate access to breast and cervical cancer screenings for prevention specifically in the Medicaid program. Objectives: To discern if there are prevailing standards for access for breast and cervical cancer screening, to understand accessibility and its various components more thoroughly, to gain a deeper insight into breast and cervical cancer prevention, and to explore and document methods for research on screening standards in order to guide others who may follow up on research or use for other services. Methods: This study consisted of literature searches and reviews specific to access standards, Medicaid, breast cancer, and cervical cancer. Online searches for specific contracts and contacts were targeted to various state departments of health, medical societies for breast and cervical cancer, and national organizations. For information that could not be searched, emails and phone calls were the best ways to obtain the information needed. Results: Given the research, the hypothesis was proven true. Access standards for breast and cervical cancer prevention do not exist for the organizations and departments researched. The importance of creating standards is that it allows for the measurement of access to care. The primary recommendation from this study is that access standards should be developed to measure the effectiveness of breast and cervical cancer screenings and prevention services. The second major recommendation is to develop access standards by researching the actual experience with wait-times for breast and cervical cancer screening. Since the need for access to care standards for breast and cervical cancer screening is addressed, the next question would be how to go about developing standards. Conclusions: The findings suggest there is a gap in information on breast and cervical cancer preventive services. The main recommendation is that access to care standards for breast and cervical cancer preventive services be developed in order to measure access to care in the Medicaid program. This would allow the Medicaid program's breast and cervical cancer preventive services for women to be assessed.

Medicaid

Medicaid
Author:
Publisher:
Total Pages: 39
Release: 2009
Genre:
ISBN:

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